HIV and COVID-19 inpatient outcomes: A matched retrospective multicentre analysis

ABSTRACT

Background: Clinical outcomes for people living with HIV (PLWH) hospitalized with COVID-19 infections have shown mixed outcomes. We conducted a multicentre, UK retrospective matched cohorts' analysis. Methods: Index cases were HIV+ COVID-19 PCR+ patients hospitalized between dates 1st February - 31st May 2020. HIV-negative patients were matched to PLWH up to a 31 ratio across 6 sites in England, by hospital site, test date +/- 7 days, age +/- 5 years, gender, index of multiple deprivation decile (IMDD) +/- 1. The primary outcome was patients achieving ≥2-point improvement on a 7-point ordinal scale or discharge from hospital by day 28, whichever was earlier. Follow up was right-censored at day 28 for patients still in hospital. Baseline characteristics and outcomes were analysed by Coxproportional hazards regression stratified by matching clusters using multiple imputation for missing data. The model adjusted for ethnicity, clinical frailty score, body mass index, baseline hypoxia, duration of symptoms, hypertension, diabetes, malignancy, cardiac, lung and renal disease. Results: 68 PLWH and 181 HIV-negative patients were included. PLWH had an HR of 0.57 (95%CI 0.39, 0.85;p=0.005) of achieving 2-point improvement or discharge compared to HIV-negative patients. The effect size of HIV-status was attenuated (aHR 0.70;0.43, 1.17;P=0.18) after adjustment in the multivariable model (Table 1), with baseline frailty (aHR=0.79;95%CI 0.65, 0.95;p=0.011 ), malignancy (aHR=0.37;95%CI 0.17, 0.82;p=0.014) having a greater impact on the primary outcome. Proportion of deaths (19.1% vs 19.3%, p=0.266) and patients requiring ventilation (23.5% vs 17.1%, p=0.25) were similar between PLWH and HIV-negative patients. Sensitivity analyses adjusting for age and excluding missing data, remained consistent with main findings. PLWH were frailer (median clinical frailty score 3 vs 2, p=0.0069), and had higher proportion of malignancies (14.7% vs 9.9%, p=0.29) although not statistically significant. Number of non-HIV co-morbidities (2 vs 2, p=0.16) and median BMI (27.7 vs 29.4, p=0.19) were similar. The median CD4 count of PLWH was 352cells/ μL (IQR 235, 619), and 63/68 (92.3%) were taking antiretroviral therapy. Conclusion: Although PLWH were less likely to achieve improvement or discharge, after adjustment the effect of HIV-status was attenuated. Increased baseline frailty and active malignancies remain associated with poorer COVID-19 outcomes.