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Sociodemographic, clinical, and immunological factors associated with SARS-CoV-2 diagnosis and severe COVID-19 outcomes in people living with HIV: a retrospective cohort study.
Nomah, Daniel K; Reyes-Urueña, Juliana; Díaz, Yesika; Moreno, Sergio; Aceiton, Jordi; Bruguera, Andreu; Vivanco-Hidalgo, Rosa M; Llibre, Josep M; Domingo, Pere; Falcó, Vicenç; Imaz, Arkaitz; Cortés, Cristina; Force, Lluís; Letang, Emili; Vilaró, Ingrid; Casabona, Jordi; Miro, Jose M.
  • Nomah DK; Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Dept Salut, Generalitat de Catalunya, Badalona, Spain; Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellat
  • Reyes-Urueña J; Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Dept Salut, Generalitat de Catalunya, Badalona, Spain; Institut d'Investigació Germans Trias i Pujol, Barcelona, Spain; CIBER Epidemiologia y Salud Pública, Barcelona, Spain. Electronic address:
  • Díaz Y; Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Dept Salut, Generalitat de Catalunya, Badalona, Spain; Institut d'Investigació Germans Trias i Pujol, Barcelona, Spain; CIBER Epidemiologia y Salud Pública, Barcelona, Spain.
  • Moreno S; Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Dept Salut, Generalitat de Catalunya, Badalona, Spain; Institut d'Investigació Germans Trias i Pujol, Barcelona, Spain; CIBER Epidemiologia y Salud Pública, Barcelona, Spain.
  • Aceiton J; Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Dept Salut, Generalitat de Catalunya, Badalona, Spain; Institut d'Investigació Germans Trias i Pujol, Barcelona, Spain; CIBER Epidemiologia y Salud Pública, Barcelona, Spain.
  • Bruguera A; Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Dept Salut, Generalitat de Catalunya, Badalona, Spain; Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellat
  • Vivanco-Hidalgo RM; Agència de Qualitat i Avaluació Sanitàries de Catalunya, Barcelona, Spain.
  • Llibre JM; Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
  • Domingo P; Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
  • Falcó V; Vall d'Hebron Research Institute, Hospital de Vall d'Hebron, Barcelona, Spain.
  • Imaz A; Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Spain.
  • Cortés C; Hospital Moises Broggi-Consorci Sanitari Integral, L'Hospitalet de Llobregat, Spain.
  • Force L; Hospital de Mataró, Mataró, Spain.
  • Letang E; Hospital del Mar, Barcelona, Spain; ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-University of Barcelona, Barcelona, Spain.
  • Vilaró I; Hospital de Vic, Vic, Spain.
  • Casabona J; Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Dept Salut, Generalitat de Catalunya, Badalona, Spain; Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellat
  • Miro JM; Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain. Electronic address: jmmiro@ub.edu.
Lancet HIV ; 8(11): e701-e710, 2021 11.
Article in English | MEDLINE | ID: covidwho-1541051
ABSTRACT

BACKGROUND:

Factors affecting outcomes of SARS-CoV-2 infection in people living with HIV are unclear. We assessed the factors associated with SARS-CoV-2 diagnosis and severe outcomes among people living with HIV.

METHODS:

We did a retrospective cohort study using data from the PISCIS cohort of people with HIV in Catalonia (Spain) between March 1 and Dec 15, 2020. We linked PISCIS data with integrated health-care, clinical, and surveillance registries through the Public Data Analysis for Health Research and Innovation Program of Catalonia (PADRIS) to obtain data on SARS-CoV-2 diagnosis, chronic comorbidities, as well as clinical and mortality outcomes. Participants were aged at least 16 years in care at 16 hospitals in Catalonia. Factors associated with SARS-CoV-2 diagnoses and severe outcomes were assessed using univariable and multivariable Cox regression models. We estimated the effect of immunosuppression on severe outcomes (hospital admission for >24 h with dyspnoea, tachypnoea, hypoxaemia, asphyxia, or hyperventilation; or death) using Kaplan-Meier survival analysis.

FINDINGS:

We linked 20 847 (72·8%) of 28 666 participants in the PISCIS cohort with PADRIS data; 13 142 people had HIV. 749 (5·7%) people with HIV were diagnosed with SARS-CoV-2 their median age was 43·5 years (IQR 37·0-52·7), 131 (17·5%) were female, and 618 (82·5%) were male. 103 people with HIV (13·8%) were hospitalised, seven (0·9%) admitted to intensive care, and 13 (1·7%) died. SARS-CoV-2 diagnosis was more common among migrants (adjusted hazard ratio 1·55, 95% CI 1·31-1·83), men who have sex with men (1·42, 1·09-1·86), and those with four or more chronic comorbidities (1·46, 1·09-1·97). Age at least 75 years (5·2, 1·8-15·3), non-Spanish origin (2·1, 1·3-3·4), and neuropsychiatric (1·69, 1·07-2·69), autoimmune disease (1·92, 1·14-3·23), respiratory disease (1·84, 1·09-3·09), and metabolic disease (2·59, 1·59-4·23) chronic comorbidities were associated with increased risk of severe outcomes. A Kaplan-Meier estimator showed differences in the risk of severe outcomes according to CD4 cell count in patients with detectable HIV RNA (p=0·039) but no differences were observed in patients with undetectable HIV RNA (p=0·15).

INTERPRETATION:

People living with HIV with detectable HIV viraemia, chronic comorbidities, and some subpopulations could be at increased risk of severe outcomes from COVID-19. These groups should be prioritised in clinical management and SARS-CoV-2 vaccination programmes.

FUNDING:

Fundació "la Caixa". TRANSLATIONS For the Catalan, Spanish and Russian translations of the Summary see Supplementary Materials section.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Immunoglobulin G / HIV Infections / SARS-CoV-2 / COVID-19 Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid / Vaccines / Variants Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Lancet HIV Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Immunoglobulin G / HIV Infections / SARS-CoV-2 / COVID-19 Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid / Vaccines / Variants Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Lancet HIV Year: 2021 Document Type: Article