Background Studies on COVID-19 in people with HIV (PWH) had limitations. Further investigations on risk factors and outcomes of SARS-CoV-2 infection among PWH are needed. Methods This retrospective cohort study leveraged the national OPTUM COVID-19 dataset to investigate factors associated with SARS-CoV-2 positivity among PWH and risk factors for severe outcomes including hospitalization, Intensive Care Unit stays, and death. A subset analysis was conducted to examine HIV-specific variables. Multiple variable logistic regression was used to adjust for covariates. Results Of 43,173 PWH included in this study, 6,472 had a positive SARS-CoV-2 PCR or antigen test. For SARS-CoV-2 positivity, higher odds were among younger PWH (18-49 years), Hispanic Whites, African Americans, US South, uninsured, higher BMI, non-current smokers, and higher Charlson comorbidity index (CCI). When examining severe outcomes, higher odds were among SARS-CoV-2 positive; older PWH; US South; Medicaid, Medicare, or uninsured; current smokers; underweight; and higher CCI. In a subset analysis including PWH with HIV care variables (n = 5,098), those with unsuppressed HIV VL, low CD4 count, and not on ART had higher odds of severe outcomes. Conclusions This large US study found significannt ethnic, racial, and geographical differences in SARS-CoV-2 infection among PWH. Chronic comorbidities, older age, lower BMI, and smoking were associated with severe outcomes among PWH during the COVID-19 pandemic. SARS-CoV-2 infection was associated with severe outcomes, but once we adjusted for HIV-care variables, SARS-CoV-2 was no longer significant, while low CD4 count, high viral load, and lack of ART usage had higher odds of severe outcomes.

OBJECTIVES: Throughout the pandemic, children with COVID-19 have experienced hospitalization, ICU admission, invasive respiratory support, and death. Using a multisite, national dataset, we investigate risk factors associated with these outcomes in children with COVID-19. METHODS: Our data source (Optum deidentified COVID-19 Electronic Health Record Dataset) included children aged 0 to 18 years testing positive for COVID-19 between January 1, 2020, and January 20, 2022. Using ordinal logistic regression, we identified factors associated with an ordinal outcome scale: nonhospitalization, hospitalization, or a severe composite outcome (ICU, intensive respiratory support, death). To contrast hospitalization for COVID-19 and incidental positivity on hospitalization, we secondarily identified patient factors associated with hospitalizations with a primary diagnosis of COVID-19. RESULTS: In 165 437 children with COVID-19, 3087 (1.8%) were hospitalized without complication, 2954 (1.8%) experienced ICU admission and/or intensive respiratory support, and 31 (0.02%) died. We grouped patients by age: 0 to 4 years old (35 088), and 5 to 11 years old (75 574), 12 to 18 years old (54 775). Factors positively associated with worse outcomes were preexisting comorbidities and residency in the Southern United States. In 0- to 4-year-old children, there was a nonlinear association between age and worse outcomes, with worse outcomes in 0- to 2-year-old children. In 5- to 18-year-old patients, vaccination was protective. Findings were similar in our secondary analysis of hospitalizations with a primary diagnosis of COVID-19, though region effects were no longer observed. CONCLUSIONS: Among children with COVID-19, preexisting comorbidities and residency in the Southern United States were positively associated with worse outcomes, whereas vaccination was negatively associated. Our study population was highly insured; future studies should evaluate underinsured populations to confirm generalizability.