RESUMEN
Background: People with HIV (PWH) are at a higher risk of severe acute COVID-19;however, their risk of subsequently developing post-acute sequelae of SARS-CoV2 (PASC) remains unclear. Furthermore, although vaccination has been shown to be protective against PASC in the general population, few studies have evaluated its effectiveness in PWH. Method(s): We used the TriNetX health research database to source data from 69 healthcare organizations within the US. We included any adults aged >= 18 years with positive SARS-CoV-2 between January 1, 2020 and September 16, 2022 and categorized them based on their HIV status, baseline sociodemographic characteristics, comorbidities and COVID-19 vaccination status. The primary outcome was risk of PASC, compared by HIV and vaccination status after 1:1 propensity score matching. PASC was defined as either the persistence of COVID-attributable symptoms or the occurrence of new-onset health conditions at least 28 days following COVID-19 diagnosis. For all analysis, statistical significance was set at p < 0.05. Result(s): Of 3,048,792 people with confirmed SARS-CoV-2 infection, 1% (n=28,904) were PWH, with 9% of PWH (n=2592) vaccinated. At 28 days post-COVID-19 diagnosis, PWH had lower mortality compared with their non-HIV counterparts (OR 0.78, 95% CI 0.70-0.87), but higher risk of developing new-onset diabetes (DM) (OR 1.26, 95% CI 1.11-1.42), heart disease (OR 1.27, 95% 1.14-1.41), malignancy (OR 1.66, 95% CI 1.45-1.89), thrombosis (OR 1.25, 95% CI 1.12-1.39) and mental health disorders (OR 1.70 (95% CI 1.53-1.90). Furthermore, vaccinated PWH had significantly lower odds of death (OR 0.63, 95% CI 0.42- 0.93) and each new-onset PASC outcome, as follows: DM (OR 0.51, 95% CI 0.32- 0.82), heart disease (OR 0.44, 95% CI 0.29-0.67), malignancy (OR 0.43 (95% CI 0.25-0.74), thrombosis (OR 0.51, 95% CI 0.33-0.78) and mental health disorders (OR 0.49, 95% CI 0.30-0.79). The risk of PASC was higher during the pre-Delta variant period but did not vary based on CD4 count or HIV viremia. Conclusion(s): HIV infection confers a higher risk of PASC. Importantly, COVID-19 vaccination significantly lowered mortality and was protective against PASC among PWH. With the increase in the number of COVID-19 survivors, vaccination offers an effective preventive strategy to address a burgeoning public health problem. (Table Presented).
RESUMEN
Background: HIV infection is considered a risk factor for severe SARS-CoV-2 (COVID-19) infection;however, there are limited studies assessing the impact of HIV on COVID-19 presentation and clinical outcomes. Methods: We used TriNetX (a large global health research network) to compare adult HIV and non-HIV patients with confirmed SARS-CoV-2 infection who sought care across 44 healthcare facilities in the US January to December 2020. We assessed demographic characteristics, comorbidities, presenting symptoms, laboratory parameters, rate of hospitalization, rate of intensive care service utilization requiring mechanical ventilation and mortality at 30 days after diagnosis. Continuous data were compared using independent t-tests and categorical data were compared using Chi-square or Fishers exact test, as appropriate. Potential confounders were addressed using 1:1 greedy nearest-neighbor propensity score matching based on demographics and key comorbidities. For outcomes of interest, we calculated odds ratios (OR) and 95% confidence intervals (CI), with p < 0.05 considered statistically significant in all analyses. Results: Of 297194 confirmed COVID-19 cases, 1638 (0.6%) were HIV-infected, with > 83% on antiretroviral therapy (ART) and 48% virally suppressed (HIV-1 RNA < 20 copies/μL). Compared with their non-HIV counterparts, HIV patients were more commonly younger (p < 0.001), male (p < 0.001), African American or Hispanic (p < 0.001), had more cardiovascular disease (p < 0.001) and other comorbidities, were more symptomatic at presentation and had higher utilization of all healthcare services (Table 1). On laboratory parameters, HIV patients were more anemic (p < 0.001), thrombocytopenic (p < 0.001) and had elevated serum creatinine (p < 0.001), procalcitonin (p=0.042) and interleukin-6 (p=0.010) levels. In propensity score-matched analysis by demographics and relevant comorbidities, HIV patients had significantly higher odds of hospitalization [OR 1.26, 95% CI (1.04-1.53);p=0.023] and severe illness requiring intensive care stay and mechanical ventilation [OR 1.32, 95% CI (1.10-1.58);p=0.003]. Mortality at 30 days was higher among HIV patients but did not attain statistical significance (2.9% vs 2.3%;p=0.123). Conclusion: In one the largest studies to date, HIV patients had more underlying risk factors, symptom severity and higher odds of hospitalizationand mechanical ventilation but were not significantly more at risk of death at 30 days after COVID-19 diagnosis compared to non-HIV controls. (Figure Presented).