Clinical features and outcomes of COVID-19 among people living with HIV in the United States: A multicenter study from a large global health research network (TriNetX)

Yendewa, George A; Perez, Jaime Abraham; Schlick, Kayla; Tribout, Heather; McComsey, Grace A

BACKGROUND: HIV infection is a presumed risk factor for severe COVID-19, yet little is known about COVID-19 outcomes in people with HIV (PLW). METHODS: We used the TriNetX database to compare COVID-19 outcomes of PWH and HIV negative controls aged ≥ 18 years who sought care in 44 healthcare centers in the US from January 1 to December 1, 2020. Outcomes of interest were rates of hospitalization (composite of inpatient non-intensive care (ICU) and ICU admissions), mechanical ventilation, severe disease (ICU admission or death) and 30-day mortality. RESULTS: Of 297,194 confirmed COVID-19 cases, 1638 (0.6%) were HIV-infected, with > 83% on antiretroviral therapy (ART) and 48% virally suppressed. Overall, PWH were more commonly younger, male, African American or Hispanic, had more comorbidities, were more symptomatic, and had elevated procalcitonin and interleukin 6. Mortality at 30 days was comparable between the two groups (2.9% vs 2.3%; p=0.123); however, PWH had higher rates hospitalization (16.5% vs 7.6%, p<0.001), ICU admissions (4.2% vs 2.3%, p<0.001) and mechanical ventilation (2.4% vs 1.6%, p<0.005). Among PWH, hospitalization was independently associated with male gender, being African American, integrase inhibitor use and low CD4 count; whereas severe disease was predicted by older age [adjusted odds ratio (aOR) 8.33, 95% confidence interval (CI) (1.06, 50.00); p=0.044] and CD4 <200 cells/mm (3) [aOR, 8.33, 95% CI (1.06, 50.00); p=0.044]. CONCLUSION: PWH had higher rates of poor COVID-19 outcomes but were not more at risk of death than non-HIV infected counterparts. Older age and low CD4 count predicted adverse outcomes.