HIV infection and COVID-19 death: a population-based cohort analysis of UK primary care data and linked national death registrations within the OpenSAFELY platform

Abstract

Background Whether HIV infection is associated with risk of death due to COVID-19 is unclear. We aimed to investigate this association in a large-scale population-based study in England. MethodsWe did a retrospective cohort study. Working on behalf of NHS England, we used the OpenSAFELY platform to analyse routinely collected electronic primary care data linked to national death registrations. We included all adults (aged ≥18 years) alive and in follow-up on Feb 1, 2020, and with at least 1 year of continuous registration with a general practitioner before this date. People with a primary care record for HIV infection were compared with people without HIV. The outcome was COVID-19 death, defined as the presence of International Classification of Diseases 10 codes U07.1 or U07.2 anywhere on the death certificate. Cox regression models were used to estimate the association between HIV infection and COVID-19 death; they were initially adjusted for age and sex, then we added adjustment for index of multiple deprivation and ethnicity, and then for a broad range of comorbidities. Interaction terms were added to assess effect modification by age, sex, ethnicity, comorbidities, and calendar time.Results 17 282 905 adults were included, of whom 27 480 (0•16%) had HIV recorded. People living with HIV were more likely to be male, of Black ethnicity, and from a more deprived geographical area than the general population. 14 882 COVID-19 deaths occurred during the study period, with 25 among people with HIV. People living with HIV had higher risk of COVID-19 death than those without HIV after adjusting for age and sex: hazard ratio (HR) 2•90 (95% CI 1•96-4•30; p<0•0001). The association was attenuated, but risk remained high, after adjustment for deprivation, ethnicity, smoking and obesity: adjusted HR 2•59 (95% CI 1•74-3•84; p<0•0001). There was some evidence that the association was larger among people of Black ethnicity: HR 4•31 (95% CI 2•42-7•65) versus 1•84 (1•03-3•26) in non-Black individuals (p-interaction=0•044).Interpretation People with HIV in the UK seem to be at increased risk of COVID-19 mortality. Targeted policies should be considered to address this raised risk as the pandemic response evolves.

ChAdOx1 nCoV-19 (AZD1222) Vaccine in People Living With and Without HIV

“…In the United States of America, PLWH have been shown to have a greater risk for COVID-19 hospitalization compared with HIV-negative individuals 20 , while studies in the United Kingdom have shown that underlying HIV infection is associated with a greater risk for COVID-19 death, with higher associations in people of Black ethnicity compared with non-Black individuals 5 . In South Africa, HIV infection has been associated with an increased risk of death from COVID-19, irrespective of HIV-1 viral load and immunosuppression 35 .…”

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Coronavirus disease 2019 (COVID-19) is a public health emergency of international concern 1 . People living with HIV (PLWH) are at increased risk for adverse COVID-19 outcomes compared with HIV-negative individuals [2][3][4][5] , and are a high-risk group for COVID-19 prevention 4 . The ChAdOx1 nCoV-19 (AZD1222) vaccine has demonstrated safety and e cacy against COVID-19 in clinical trials [6][7][8] .

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Human immunodeficiency virus and mortality from coronavirus disease 2019: A systematic review and meta-analysis

“…Results from observational studies have been conflicting. 17,18,19,20 This meta-analysis aims to explore the impact of HIV and SARS-CoV-2 co-infection on the mortality outcomes of COVID-19 based on available observational studies.…”

Characterization of humoral and SARS-CoV-2 specific T cell responses in people living with HIV

“…These multi-morbidities are driven by residual inflammation on ART and ongoing immune dysregulation 7 that could influence COVID-19 disease severity, the durability of protective antiviral responses, which may prevent future reinfection, and responsiveness to vaccination 8,9 . Although there is no evidence of increased rates of COVID-19 disease among PLWH compared to the general population, mortality estimates vary between studies, with disparities in social health determinants and comorbidities likely having an influence [10][11][12][13][14][15][16] . More recently, cellular immune deficiency and a lower CD4 T cell count/low CD4 T cell nadir have been identified as potential risk factors for severe SARS-CoV-2 infection in PLWH, irrespective of HIV virological suppression 17 .…”