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IMPACT of AGING in HIV on COVID-19 OUTCOMES VIA A MATCHED STUDY
Topics in Antiviral Medicine ; 30(1 SUPPL):363, 2022.
Article in English | EMBASE | ID: covidwho-1880304
ABSTRACT

Background:

HIV infection might accelerate aging process and people living with HIV (PLWH) have been observed to have a higher risk of severe COVID-19 outcomes. However, it is unclear whether the worse COVID-19 outcomes can be attributed to the accelerated aging process. This study aimed to examine 1) the causal effect of HIV infection on severe COVID-19 outcomes;and 2) the threshold of age difference at which PLWH and non-HIV patients will have comparable COVID-19 outcomes.

Methods:

We identified COVID-19 positive adults between Jan 1, 2020, and Oct 18, 2021, from the U.S. National COVID Cohort Collaborative (N3C), a nationally-sampled electronic medical record repository. We identified PLWH by clinical diagnosis, drug exposure, and laboratory results. Among COVID-19 cases, PLWH were matched 11 to non-HIV persons using exact matching (by gender, race, and ethnicity) and propensity score matching (PSM) (by age, gender, race, ethnicity, and pre-COVID comorbidities). To determine age threshold, PLWH were matched to older non-HIV patients with an age differences between 1 to 15 years. We used conditional logistic regression for exact matched data and standard logistic regression for PSM data. Subgroup analyses stratified by CD4 counts (≥200 or CD4<200 cells/mm) were also conducted.

Results:

Among a total of 2,422,870 COVID-19 positive adults, we identified 15,188 PLWH. Among PLWH with CD4 data, 872 (14.03%) had CD4<200. Using exact match, PLWH had a significantly higher odds of COVID-19-associated hospitalization [OR 1.95, 95%CI(1.88,2.02)] or death [OR 2.05, 95%CI(1.90,2.22)] compared to non-HIV persons. By repeating PSM modeling with incrementally increasing ages, PLWH persistently had a higher risk of death compared to non-HIV persons until the age difference reached 6 years, while the threshold of age difference for the comparable hospitalization outcome extended to 14 years. Furthermore, when matching PLWH with CD4<200 with non-HIV persons, the threshold of age difference increased to 10 years for similar odds of mortality and at least 15 years for similar odds of hospitalization. PLWH with CD4≥200 more likely to be hospitalized, though had similar outcomes for death, than non-HIV persons.

Conclusion:

We find that the worse COVID-19 outcomes, among PWH may be potentially related to aging in HIV. Further investigation of the biological mechanisms at the intersections of HIV infection itself (eg, lower CD4 counts) and accelerated aging in HIV causing worse COVID-19 outcomes is needed.
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Collection: Databases of international organizations Database: EMBASE Type of study: Experimental Studies Language: English Journal: Topics in Antiviral Medicine Year: 2022 Document Type: Article

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Collection: Databases of international organizations Database: EMBASE Type of study: Experimental Studies Language: English Journal: Topics in Antiviral Medicine Year: 2022 Document Type: Article