12-MONTH CONSEQUENCES IN PEOPLE WITH HIV/SARS-CoV-2 COINFECTION: NATIONAL EHR COHORT

ABSTRACT

Background: Long-term consequences of COVID-19 are well characterized in general populations. Yet it remains unclear how existing HIV infection attributes to the risks of long-term consequences in people with coinfection of HIV/SARSCoV- 2. This study aims to examine the long-term consequences of people living with HIV (PLWH) at 12 months after the first SARS-CoV-2 infection. Method(s) Using the National COVID Cohort Collaborative (N3C), Electronic Health Records (EHR) sampled from 50 states and over 75 healthcare systems in the US, we constructed a cohort of PLWH with COVID-19 between March 1, 2020 and January 15, 2021, a historical control group (HIV individuals without COVID-19 between March 1, 2018 and January 15, 2019, two years predating the pandemic), and a contemporary control group (PLWH without COVID-19 between March 1, 2020 and January 15, 2021) to mitigate time/selection biases. The time of HIV infection was before March 1, 2020 for the cases and contemporary controls and, before March 1, 2018 for historical controls. The date of the first COVID-19 infection marked the start of a 12-month follow-up in the COVID-19 group. The start of follow-up in the contemporary controls was assigned by matching the same distribution of start dates of COVID-19 cases. We used logistic regression to examine odds ratios of health consequences at 12 months post COVID-19 comparing against contemporary and historical controls, respectively. Result(s) We identified 5,619, 41,791, and 24,240 patients for COVID-19 cases, contemporary controls, and historical controls, respectively. The COVID-19 group had significantly higher odds in acute respiratory distress syndrome [OR 3.45, 95% CI (2.98, 3.99)], hypertension [OR 1.41, 95% CI (1.29, 1.54)], congestive heart failure [OR 1.36, 95% CI (1.14, 1.63)], myocardial infarction [OR 1.51, 95% CI (1.22, 1.86)], and diabetes [OR 1.62, 95% CI (1.42, 1.84)], compared to contemporary controls. Odds in these outcomes were significantly higher when compared to historical controls (Figure 1). Conclusion(s) This sentinel study for the first time reported elevated risks of multi-system dysfunction (i.e., respiratory, cardiovascular, and metabolic) among PLWH at 12 months post COVID-19. To our knowledge, it is the largest EHR cohort study assessing long-term consequences in PLWH. Our findings call for immediate attention to the post-COVID care among PLWH, including followup guidelines, care planning, and health policy tailored for PLWH.