COVID-19 Disease Severity among People with HIV Infection or Solid Organ Transplant in the United States: A Nationally-representative, Multicenter, Observational Cohort Study

Abstract

Background Individuals with immune dysfunction, including people with HIV (PWH) or solid organ transplant recipients (SOT), might have worse outcomes from COVID-19. We compared odds of COVID-19 outcomes between patients with and without immune dysfunction. Methods We evaluated data from the National COVID-19 Cohort Collaborative (N3C), a multicenter retrospective cohort of electronic medical record (EMR) data from across the United States, on. 1,446,913 adult patients with laboratory-confirmed SARS-CoV-2 infection. HIV, SOT, comorbidity, and HIV markers were identified from EMR data prior to SARS-CoV-2 infection. COVID-19 disease severity within 45 days of SARS-CoV-2 infection was classified into 5 categories: asymptomatic/mild disease with outpatient care; mild disease with emergency department (ED) visit; moderate disease requiring hospitalization; severe disease requiring ventilation or extracorporeal membrane oxygenation (ECMO); and death. We used multivariable, multinomial logistic regression models to compare odds of COVID-19 outcomes between patients with and without immune dysfunction. Findings Compared to patients without immune dysfunction, PWH and SOT had a greater likelihood of having ED visits (adjusted odds ratio [aOR]: 1.28, 95% confidence interval [CI] 1.27-1.29; aOR: 2.61, CI: 2.58-2.65, respectively), requiring ventilation or ECMO (aOR: 1.43, CI: 1.43-1.43; aOR: 4.82, CI: 4.78-4.86, respectively), and death (aOR: 1.20, CI: 1.19-1.20; aOR: 3.38, CI: 3.35-3.41, respectively). Associations were independent of sociodemographic and comorbidity burden. Compared to PWH with CD4>500 cells/mm3, PWH with CD4<350 cells/mm3 were independently at 4.4-, 5.4-, and 7.6-times higher odds for hospitalization, requiring ventilation, and death, respectively. Increased COVID-19 severity was associated with higher levels of HIV viremia. Interpretation Individuals with immune dysfunction have greater risk for severe COVID-19 outcomes. More advanced HIV disease (greater immunosuppression and HIV viremia) was associated with higher odds of severe COVID-19 outcomes. Appropriate prevention and treatment strategies should be investigated to reduce the higher morbidity and mortality associated with COVID-19 among PWH and SOT.

Humoral immunity against SARS‐CoV‐2 variants including omicron in solid organ transplant recipients after three doses of a COVID‐19 mRNA vaccine

“… 7 , 8 , 9 , 10 Solid organ transplant recipients (SOTR) with COVID‐19 also show an increased mortality of > 20%. 11 , 12 , 13 , 14 , 15 , 16 , 17 In these patients, advanced age and comorbidities such as cardiovascular and pulmonary disease seem to contribute to the reduced survival. 18 , 19 , 20 …”

“…[7][8][9][10] Solid organ transplant recipients (SOTR) with COVID-19 also show an increased mortality of > 20%. [11][12][13][14][15][16][17] In these patients, advanced age and comorbidities such as cardiovascular and pulmonary disease seem to contribute to the reduced survival. [18][19][20] The development of anti-SARS-CoV-2 antibodies following an active infection and/or vaccination, especially those directed against the S/RBD proteins of the virus, is crucial for the (1) protection from future COVID-19 infections, (2) limiting disease severity and (3) controlling viral transmission.…”

Factors associated with severity of COVID-19 disease in a multicenter cohort of people with HIV in the United States, March-December 2020

“…The proportions of PWH with COVID-19 requiring hospitalization (16%) and intensive care (5%) and who died (2%) are lower than proportions reported in a Spanish national cohort of PWH with COVID-19 early in the pandemic (64% hospitalized, 6% ICU, 8% died) 36 , and PWH in New York City with COVID-19 in March-June 2020 (42%, 5%, 13%, respectively) 37 , which may be explained in part by overwhelmed healthcare capacity during the limited time period of those early cohort studies. In contrast, PWH in a Spanish (PISCIS) registry through December 2020 and US national registry of COVID-19 patients (NC3 Cohort) through May 2021, had similar rates of severe outcomes (PISCIS: 13.8%, 0.9%, 1.7%; NC3: 32%, 4%, 2%, respectively) to our cohort 38,39 .…”

Clinical outcomes of patients with and without HIV hospitalized with COVID‐19 in England during the early stages of the pandemic: a matched retrospective multi‐centre analysis (RECEDE‐C19 study)

“…There is increasing evidence from large population‐based studies that suggest people living with HIV (PLWH) have a higher risk of severe COVID‐19 and worse outcomes. Reports from large population‐based cohorts from the USA [5], the UK [6,7], South Africa [8] and the World Health Organization [9] suggest there is increased mortality from COVID‐19 amongst PLWH. However, these cohorts were often limited by incomplete data and lack of data on CD4 T‐cell count, viral load or HIV treatment.…”