Bacterial pneumonia is more frequent in HIV-positive persons than in seronegative controls, and the risk is highest among those with CD4 lymphocyte counts below 200 per cubic millimeter and among injection-drug users.

Background Emerging evidence suggests many people have persistent symptoms after acute COVID-19 illness. Our objective was to estimate the prevalence and correlates of post-acute sequelae of SARS-CoV-2 infection (PASC). Methods We employed a population-based probability survey of adults with COVID-19 in Michigan. Living non-institutionalized adults aged 18+ in the Michigan Disease Surveillance System with COVID-19 onset through mid-April 2020 were eligible for selection (n=28,000). Among 2,000 selected, 629 completed the survey between June - December 2020. We estimated PASC prevalence, defined as persistent symptoms 30+ (30-day COVID-19) or 60+ days (60-day COVID-19) post COVID-19 onset, overall and by sociodemographic and clinical factors, including self-reported symptom severity and hospitalization status. We used modified Poisson regression to produce adjusted prevalence ratios (aPR) for potential risk factors. Results The analytic sample (n=593) was predominantly female (56.1%), aged 45 and older (68.2%), and Non-Hispanic White (46.3%) or Black (34.8%). 30- and 60-day COVID-19 were highly prevalent (52.5% and 35.0%), even among non-hospitalized respondents (43.7% and 26.9%) and respondents reporting mild symptoms (29.2% and 24.5%). Respondents reporting very severe (vs. mild) symptoms had 2.25 times higher prevalence of 30-day COVID-19 ([aPR] 2.25, 95% CI 1.46-3.46) and 1.71 times higher prevalence of 60-day COVID-19 (aPR 1.71, 95% 1.02-2.88). Hospitalized (vs. non-hospitalized) respondents had about 40% higher prevalence of both 30-day (aPR 1.37, 95% CI 1.12-1.69) and 60-day COVID-19 (aPR 1.40, 95% CI 1.02-1.93). Conclusions PASC is highly prevalent among cases reporting severe initial symptoms, and, to a lesser extent, cases reporting mild and moderate symptoms.

To determine the prevalence, incidence, and types of lung diseases that occur in association with HIV infection, 1,353 subjects, including HIV-seropositive homosexual men, injection drug users, female sexual partners of HIV-positive men, and HIV-seronegative control subjects from the first two transmission categories were evaluated prospectively in a multicenter study. Patients with AIDS at the time of initial evaluation were excluded. One thousand two-hundred ninety-four subjects who had no AIDS-defining diagnosis within 3 mo of enrollment had measurements of FVC, FEV1 and DLCO at the time of enrollment. As a group, all subjects had mean values of FVC and FEV1 close to 100% predicted. Those with CD4 counts below 200/mm3 had slightly reduced DLCO compared with the others. Subjects with a history of HIV-associated symptoms (thrush, weight loss, herpes zoster) also had a reduced DLCO compared with those without symptoms. Injection drug users had reduced FVC, FEV1 and DLCO compared with homosexual men and female sexual partners of HIV-infected men, with DLCO more substantially reduced. Part of the reduction in DLCO in drug users was attributable to factors other than HIV infection, especially cigarette smoking and race. Using predicted values that take cigarette smoking into account, the prevalence of abnormality in DLCO was higher among injection drug users (33.3%) than among homosexual men (11.2%) and female sexual partners (12.7%). These results show that advanced HIV infection, characterized by CD4 count < 200/mm3 or HIV-associated symptoms, and factors unrelated to HIV infection, including race, cigarette smoking, and injection drug use, are all associated with reductions in DLCO measurements.

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Importance: Emerging evidence suggests many people have persistent symptoms after acute COVID-19 illness. Objective: To estimate the prevalence and correlates of persistent COVID-19 symptoms 30 and 60 days post onset using a population-based sample. Design & Setting: The Michigan COVID-19 Recovery Surveillance Study is a population-based cross-sectional survey of a probability sample of adults with confirmed COVID-19 in the Michigan Disease Surveillance System (MDSS). Respondents completed a survey online or via telephone in English, Spanish, or Arabic between June - December 2020. Participants: Living non-institutionalized adults (aged 18+) in MDSS with COVID-19 onset through mid-April 2020 were eligible for selection (n=28,000). Among 2,000 adults selected, 629 completed the survey. We excluded 79 cases during data collection due to ineligibility, 6 asymptomatic cases, 7 proxy reports, and 24 cases missing outcome data, resulting in a sample size of 593. The sample was predominantly female (56.1%), aged 45 and older (68.2%), and Non-Hispanic White (46.3%) or Black (34.8%). Exposures: Demographic (age, sex, race/ethnicity, and annual household income) and clinical factors (smoking status, body mass index, diagnosed comorbidities, and illness severity). Main outcomes and Measures: We defined post-acute sequelae of SARS-CoV-2 infection (PASC) as persistent symptoms 30+ days (30-day COVID-19) or 60+ days (60-day COVID-19) post COVID-19 onset. Results: 30- and 60-day COVID-19 were highly prevalent (52.5% and 35.0%), even among respondents reporting mild symptoms (29.2% and 24.5%) and non-hospitalized respondents (43.7% and 26.9%, respectively). Low income was statistically significantly associated with 30-day COVID-19 in adjusted models. Respondents reporting very severe (vs. mild) symptoms had 2.25 times higher prevalence of 30-day COVID-19 (Adjusted Prevalence Ratio [aPR] 2.25, 95% CI 1.46-3.46) and 1.71 times higher prevalence of 60-day COVID-19 (aPR 1.71, 95% 1.02-2.88). Hospitalized (vs. non-hospitalized) respondents had about 40% higher prevalence of both 30-day (aPR 1.37, 95% CI 1.12-1.69) and 60-day COVID-19 (aPR 1.40, 95% CI 1.02-1.93). Conclusions and Relevance: PASC is highly prevalent among cases with severe initial symptoms, and, to a lesser extent, cases with mild and moderate symptoms.