Risk Factors for Hospitalization in People With HIV and COVID-19

Kamis, Kevin; Barbera, Lauren; Abdo, Mona; Rowan, Sarah; Hussain, Cory; Gardner, Edward M.; Johnson, Steven C.; MaWhinney, Samantha; Davis, Amelia J; Carlson, Jesse J; Kozacka, Katie A; Erlandson, Kristine M.

doi:10.1097/qai.0000000000002780

Cited by 12 publications

(14 citation statements)

References 15 publications

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“…Similarly-among 2988 PLWH diagnosed with COVID-19 in New York State-the mortality rate was higher compared to those without HIV (standardized RR, 1.23 (95% CI, 1.07-1.40)) [33 [34], within the US TriNetX database [54], as well as in the Western Cape Province, South Africa (AHR 2.36; 95% CI: 1.47-3.78) [17] analysis. A similar risk profile for PLWH with lower CD4 counts was seen inn a multi-center registry of PLWH in the USA which included 286 hospitalized PLWH [55], in the University of Colorado Health System among 206 PLWH with COVID-19 [56], and in a health system cohort in San Francisco among 136 PLWH with COVID-19 [36]. Having a CD4 + T-cell count nadir < 200 cells/mm 3 was additionally associated with hospitalization in a multi-center cohort of PLWH in the USA which included 649 cases of COVID-19 (ARR 1.67; 95% CI 1.18-2.36) [57••].…”

Section: Risk Of Severe Covid-19 Among Plwh and Its Risk Factorsmentioning

confidence: 55%

COVID-19 Outcomes and Risk Factors Among People Living with HIV

2022

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Purpose of Review In this review, we examine the intersection of the HIV and COVID-19 epidemics with focus on COVID-19-related health outcomes and risk factors for SARS-CoV-2 among people living with HIV (PLWH). Recent Findings Evidence to date do not suggest a higher incidence of SARS-CoV-2 infection among PLWH compared to the general population, although—once exposed—PLWH are at greater risk of severe COVID-19 outcomes. Key risk factors for severe COVID-19 include non-HIV comorbidities known to be associated with severe disease, as well as HIV-specific risk factors such as low CD4 + T-cell count, unsuppressed viral load, and tuberculosis co-infection. The disproportionate impact of the SARS-CoV-2 pandemic among Black, Latinx, and Native American/Alaskan Native PLWH could worsen pre-existing disparities in health outcomes among PLWH. Data on SARS-CoV-2 vaccine protection among PLWH needs additional study, although some studies suggest decreased humoral responses among those with low CD4 + T-cell counts, while there is a signal of increased vaccine breakthrough rates among PLWH in two large observational cohorts. Data on post-acute sequelae of SARS-CoV-2 (PASC) among PLWH is also limited. Summary PLWH do not have a higher susceptibility to SARS-CoV-2, but once exposed, they are at higher risk of severe COVID-19 outcomes. Additional resources will need to be dedicated to the development of interventions to improve health outcomes and address disparities among PLWH impacted by the COVID-19 pandemic.

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Section: Risk Of Severe Covid-19 Among Plwh and Its Risk Factorsmentioning

confidence: 55%

COVID-19 Outcomes and Risk Factors Among People Living with HIV

2022

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“…46 Our results demonstrate consistent and significant increased risk of hospitalization in PWH with lower CD4 counts, an association that has been confirmed in multiple global settings. 39,47–49 While most marked in PWH with CD4 counts <200 cells/mm 3 , risk of hospitalization was significantly elevated in people with CD4 counts <350 cells/mm 3 compared with those with CD4 counts ≥350 cells/mm 3 . In addition to current CD4 count, we also found that lowest CD4 count and lower current CD4/CD8 ratio were associated with an increased risk of hospitalization, suggesting an immune exhaustion effect persisting from the time of CD4 nadir despite subsequent CD4 reconstitution.…”

Section: Discussionmentioning

confidence: 98%

Factors Associated With Severity of COVID-19 Disease in a Multicenter Cohort of People With HIV in the United States, March–December 2020

Shapiro

Ignacio

Whitney

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…PLWDH who are in care may be more engaged in healthcare services and may be more likely to access the hospital than those not in care. In addition, PLWDH have a high prevalence of comorbidities that increase the risk of severe COVID-19 infection, [29][30][31][32][33] so it is plausible that PLWDH with comorbidities may be more engaged in the healthcare system in general and thus more likely to have access to hospitalization. This study did not assess COVID-19 diagnoses among all PLWDH, so we are unable to determine the extent to which SARS-CoV-2 infection varied by vaccination status.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Vaccination and Hospitalization Among Persons Living With Diagnosed HIV in New York State

Rosenthal

Patterson

Chicoine

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background:Persons living with diagnosed HIV (PLWDH) have higher COVID-19 diagnoses rates and poorer COVID-19–related outcomes than persons living without diagnosed HIV. The intersection of COVID-19 vaccination status and likelihood of severe COVID-19 outcomes has not been fully investigated for PLWDH.Setting:New York State (NYS).Methods:We matched HIV surveillance, immunization, and hospitalization databases to compare COVID-19 vaccination and COVID-19–related hospitalizations among PLWDH during B.1.617.2 (Delta) and B.1.1.529 (Omicron) predominance.Results:Through March 4, 2022, 69,137 of the 101,205 (68%) PLWDH were fully vaccinated or boosted for COVID-19. PLWDH who were virally suppressed or in care were more often to be fully vaccinated or boosted compared with PLWDH who were not virally suppressed (77% vs. 44%) or without evidence of care (74% vs. 33%). Overall hospitalization rates were lower among virally suppressed PLWDH. During Delta predominance, PLWDH with any vaccination history who were in care had lower hospitalization rates compared with those not in care; during Omicron predominance, this was the case only for boosted PLWDH.Conclusions:Approximately 28% (28,255) of PLWDH in NYS remained unvaccinated for COVID-19, a rate roughly double of that observed in the overall adult NYS population. PLWDH of color were more often than non-Hispanic White persons to be unvaccinated, as were the virally unsuppressed and those without evidence of HIV-related care, threatening to expand existing disparities in COVID-19–related outcomes. Vaccination was protective against COVID-19–related hospitalizations for PLWDH; however, differences in hospitalization rates between fully vaccinated and unvaccinated PLWDH were smaller than those among all New Yorkers.

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Risk Factors for Hospitalization in People With HIV and COVID-19

Abstract: Each variable was added separately in the univariate models, and the variables that were found to be significantly associated with hospitalization (P , 0.05) in the univariate models were included in the multivariable models.

Cited by 12 publications

References 15 publications

COVID-19 Outcomes and Risk Factors Among People Living with HIV

COVID-19 Outcomes and Risk Factors Among People Living with HIV

Factors Associated With Severity of COVID-19 Disease in a Multicenter Cohort of People With HIV in the United States, March–December 2020

COVID-19 Vaccination and Hospitalization Among Persons Living With Diagnosed HIV in New York State

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