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

Abstract

Background: It is unclear whether HIV infection is associated with risk of COVID-19 death. We aimed to investigate this in a large-scale population-based study in England. Methods: Working on behalf of NHS England, we used the OpenSAFELY platform to analyse routinely collected electronic primary care data linked to national death registrations. People with a primary care record for HIV infection were compared to people without HIV. COVID-19 death was defined by ICD-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, initially adjusted for age and sex, then adding adjustment for index of multiple deprivation and ethnicity, and finally for a broad range of comorbidities. Interaction terms were added to assess effect modification by age, sex, ethnicity, comorbidities and calendar time. Results: 17.3 million 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. There were 14,882 COVID-19 deaths during the study period, with 25 among people with HIV. People living with HIV had nearly three-fold higher risk of COVID-19 death than those without HIV after adjusting for age and sex (HR=2.90, 95% CI 1.96-4.30). The association was attenuated but risk remained substantially raised, after adjustment for deprivation and ethnicity (adjusted HR=2.52, 1.70-3.73) and further adjustment for comorbidities (HR=2.30, 1.55-3.41). There was some evidence that the association was larger among people of black ethnicity (HR = 3.80, 2.15-6.74, compared to 1.64, 0.92-2.90 in non-black individuals, p-interaction=0.045) Interpretation: HIV infection was associated with a markedly raised risk of COVID-19 death in a country with high levels of antiretroviral therapy coverage and viral suppression; the association was larger in people of black ethnicity.

Impact of COVID‐19 in patients with concurrent co‐infections: A systematic review and meta‐analyses

“…However, a recent meta‐analysis has reported an increased pooled prevalence of HIV in COVID‐19 patients (1.22%, 95% CI, 0.61%–2.43%) in comparison to the general population of (0.65%; 95% CI, 0.48%–0.89%). Another population‐based cohort study from the UK have reported PLHIV had a higher risk of COVID‐19 death than those without HIV (HR = 2.90; 95% CI, 1.96–4.30) 55 . PLHIV should not be considered as protected from SARS‐CoV‐2 as people with low CD4 cell counts may have poorer outcomes than people with normal immunity.…”

Interrelations between COVID-19 and other disorders

“…However, it appears that well-controlled HIV individuals are not at greater of severe COVID-19 respect poorly controlled HIV individuals, which may have worse outcomes. In a large population-based study in the UK (from the Open SAFELY platform), it has been reported that individuals with HIV have more than twice the probability of dying from COVID-19 than people without HIV [ 136 ]. This conclusion was reached after adjustment for a range of potential confounders such as demographic characteristics, the factors related to the personal lifestyle, and considering any comorbidities.…”

COVID-19 death in people with HIV: interpret cautiously

“…In The Lancet HIV, Khrishnan Bhaskaran and colleagues 2 have analysed COVID-19 deaths in people with HIV from OpenSAFELY, a UK primary care database of 17·3 million adults. Mortality among the 27 480 people with HIV (0·16% of the study population) was higher than the general population with an adjusted hazard ratio of 2·59 (95% CI 1·74–3·84; p<0·0001).…”