Brief Report: COVID-19 Testing, Characteristics, and Outcomes Among People Living With HIV in an Integrated Health System

Abstract

Background: Understanding the attributes of COVID-19 clinical severity among people living with HIV (PLWH) compared with those in HIV-uninfected patients is critical for risk stratification and treatment strategies. Methods: We conducted a retrospective study at Kaiser Permanente Southern California among PLWH aged 18 years or older. We compared the incidence of SARS-CoV-2 molecular testing, COVID-19 diagnosis, and COVID-19 hospitalization among PLWH and HIV-uninfected adults. A chart review was conducted for PLWH with COVID-19 to examine viral suppression of HIV and most recent CD4 + counts in the year before COVID-19 diagnosis, known exposures to COVID-19, and clinical presentation. Results: Between March 1, 2020, and May 31, 2020, the incidence of SARS-CoV-2 molecular testing, COVID-19 diagnosis, and COVID-19 hospitalization was 551.2, 57.0, and 9.3 per 10,000 PLWH, respectively, compared with 268.4, 34.6, and 5.3 per 10,000 HIV-uninfected individuals, respectively. Among those with COVID-19, the distribution of race/ethnicity, smoking status, and comorbidities was similar in PLWH and HIV-uninfected patients; however, PLWH were mostly men, younger, and less obese than HIV-uninfected individuals. Health care utilization regarding emergency care and hospitalizations in the year before COVID-19-related hospitalization was similar between the groups. Overall, HIV was virologically suppressed in >95% of PLWH with COVID-19, and HIV viral load and CD4 + status did not differ between hospitalized and nonhospitalized patients. Conclusions: In this population of patients with well-controlled HIV infection, the incidence of testing, diagnosis, and hospitalization for COVID-19 was higher in PLWH than that in HIV-uninfected patients.

People with HIV have a higher risk of COVID‐19 diagnosis but similar outcomes to the general population

“…Like other studies, HIV status did not affect ICU admission or death in any models [ 6 , 26 ]. Our results contrast with studies that observed an increased risk of hospitalization among PWH [ 6 , 12 , 24 , 27 ]. However, most did not fully account for differences in comorbidities that probably impact the risk of COVID‐19 outcomes [ 28 , 29 ].…”

“…Despite regional variation in SARS‐CoV‐2 testing availability and indication, PWH have generally experienced lower thresholds for diagnostic testing [ 11 ]. For example, a study from Kaiser Permanente Southern California (KPSC) found a higher incidence of testing, diagnosis and COVID‐19 hospitalization in PWH than in HIV‐uninfected patients [ 24 ]. Yet PWH were designated as a potential risk group at KPSC during the study period and were prioritized for testing.…”

Effect of HIV disease and the associated moderators on COVID-19 Mortality

“…We identified twenty-one cohort studies (six prospective, fifteen retrospective) and, one case-control study comparing COVID-19-associated mortality between HIV Seropositive and HIV-sero-negative people, which we pooled in a meta-analysis (Bhaskaran et al, 2021; Braunstein et al, 2021; Chang et al, 2021; Díez et al, 2021; Durstenfeld et al, 2021; Geretti et al, 2021; Hadi et al, 2020; Karim et al, 2021; Karmen-Tuohy et al, 2020; Lee et al, 2022; Miyashita & Kuno, 2021; Nagarakanti et al, 2021; Patel et al, 2021; “Risk Factors for Coronavirus Disease 2019 (COVID-19) Death in a Population Cohort Study from the Western Cape Province, South Africa,” 2021; Sigel et al, 2020; Spinelli et al, 2021; Tesoriero et al, 2021; Venturas et al, 2021; Yang et al, 2021; Yendewa et al, 2021). Eleven of these (Braunstein et al, 2021; Chang et al, 2021; Díez et al, 2021; Durstenfeld et al, 2021; Hadi et al, 2020; Karmen-Tuohy et al, 2020; Lee et al, 2022; Nagarakanti et al, 2021; Patel et al, 2021; Yang et al, 2021; Yendewa et al, 2021) prior to mortality also, reported and compared cytokine release syndrome, defined by a specific parameter (such as intensive care unit admission) between HIV seropositive and seronegative.…”

“…In this meta-analysis of the twenty-two studies (Bhaskaran et al, 2021; Braunstein et al, 2021; Chang et al, 2021; Díez et al, 2021; Durstenfeld et al, 2021; Geretti et al, 2021; Hadi et al, 2020; Harrison et al, 2020; Jassat et al, 2021; Karim et al, 2021; Karmen-Tuohy et al, 2020; Lee et al, 2022; Miyashita & Kuno, 2021; Nagarakanti et al, 2021; Patel et al, 2021; “Risk Factors for Coronavirus Disease 2019 (COVID-19) Death in a Population Cohort Study from the Western Cape Province, South Africa,” 2021; Sigel et al, 2020; Spinelli et al, 2021; Tesoriero et al, 2021; Venturas et al, 2021; Yang et al, 2021; Yendewa et al, 2021) that accounted for COVID-19 mortality as the outcome, the risk for HIV-seropositive persons was at an excess of about 20% with a significant difference between the studies [Heterogeneity: Tau 2 = 0.08; Chi 2 = 168.59, df = 21 (P < 0.00001); I 2 = 88%] [Risk ratio = 1.19, 95% confidence interval (CI) 1.02 - 1.39] (Fig. 2).…”

COVID-19 in the Immunocompromised Host, Including People with Human Immunodeficiency Virus

“…3 Data from an insured Kaiser Permanente cohort in the United States (US) found that PWH were twice as likely to be diagnosed with COVID-19, despite being younger and having fewer co-morbidities than others in their network. 4 In the CNICS multi-site cohort of PWH in the US, the strongest predictors of having COVID-19 in 2020 were: self-identifying as Black or Hispanic, female sex, or having diabetes or hypertension. The only HIV-specific predictor of having COVID-19 in this cohort was having a history of having CD4+ cell count <=350 cells/mm 3 or a low current CD4/CD8 ratio; current CD4+ cell count, being on ART, and viral suppression were not associated with COVID-19 incidence in this cohort.…”