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A prospective case-cohort study of covid-19 in persons with hiv: Covih-19 study
Topics in Antiviral Medicine ; 29(1):248, 2021.
Article in English | EMBASE | ID: covidwho-1249965
ABSTRACT

Background:

Several large cohort studies have shown that adults with HIV (PWH) may have worse COVID-19 outcomes than non-HIV-infected persons. Whether it may be due to a higher frequency of co-morbidities or to a direct HIV effect is currently unclear.

Methods:

We performed a nation-wide multicenter prospective case-cohort study. Consecutive COVID-19-confirmed PWH (cases) admitted in 39 Spanish centers were matched 11 to COVID-19-confirmed non-HIV-infected adults (controls) for center, calendar week, age and gender. The contribution for death of HIV adjusted for co-morbidities was assessed in the whole population, and the contribution of immunological, virological, and antiretroviral factors only in the PWH group. Conditional logistic, random-effects logit and Fine-Gray competing-risks regression models were estimated.

Results:

From 26/Feb to 21/Sep 2020, 204 cases and 204 controls were included. Median (IQR) age was 54 (47-60) years and 85% were men. Among PWH, 33% had prior AIDS events, current median CD4 cells/mm3 were 521 (IQR 310-756), 14% had CD4<200/mm3, and 90% had HIV suppressed;antiretrovirals were 17% NNRTI, 23% PI, 70% InSTI, 89% NRTI, 6% TDF, 45% TAF, and 31% ABC. Chronic liver disease (aOR 8.68, 95%CI 1.51-49.97, P=0.0156), cardiovascular disease (aOR 2.09, 95%CI 1.19-3.68, P=0.0103), and obesity (aOR 0.30, 95%CI 0.19-0.49, P<0.0001) significantly differed between cases and controls. Twenty (9.8%) cases and 7 (3.4%) controls died. HIV infection was associated with a higher risk of death after adjustment for chronic liver disease, cardiovascular disease, and obesity (aOR 5.27, 95%CI 1.00-27.72, P=0.0499) and a higher incidence of death (subHR 3.45, 95%CI 1.47-8.11, P=0.0045). Increasing age, hypertension, diabetes, COPD, decreasing haemoglobin and leukocytes, and CKD-EPI eGFR ≤90 mL/min/1.73 m2 were associated with death in cases, while increasing age and neoplasia were associated with death in controls. Only increasing age and COPD in cases and neoplasia in controls remained associated with death in the adjusted logistic regression. Current or nadir CD4 counts and CD4/CD8 ratio, detectable HIV RNA, and specific antiretroviral agents were not associated with death.

Conclusion:

In this cohort of COVID-19 in-patients, risk of death was higher in PWH than in non-HIV-infected controls. Several co-morbidities through increasing age, but not immunological, virological, or antiretroviral factors, were associated with a higher risk of death in PWH.
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Collection: Databases of international organizations Database: EMBASE Type of study: Cohort study / Observational study / Prognostic study Language: English Journal: Topics in Antiviral Medicine Year: 2021 Document Type: Article

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Collection: Databases of international organizations Database: EMBASE Type of study: Cohort study / Observational study / Prognostic study Language: English Journal: Topics in Antiviral Medicine Year: 2021 Document Type: Article