Outcomes of COVID-19 related hospitalization among people with HIV in the ISARIC WHO Clinical Characterization Protocol (UK) : a prospective observational study
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BACKGROUND: Evidence is conflicting about how HIV modulates COVID-19. We compared the presentation characteristics and outcomes of adults with and without HIV who were hospitalized with COVID-19 at 207 centers across the United Kingdom and whose data were prospectively captured by the ISARIC WHO CCP study. METHODS: We used Kaplan-Meier methods and Cox regression to describe the association between HIV status and day-28 mortality, after separate adjustment for sex, ethnicity, age, hospital acquisition of COVID-19 (definite hospital acquisition excluded), presentation date, ten individual comorbidities, and disease severity at presentation (as defined by hypoxia or oxygen therapy). RESULTS: Among 47,592 patients, 122 (0.26%) had confirmed HIV infection and 112/122 (91.8%) had a record of antiretroviral therapy. At presentation, HIV-positive people were younger (median 56 versus 74 years; p<0.001) and had fewer comorbidities, more systemic symptoms and higher lymphocyte counts and C-reactive protein levels. The cumulative day-28 mortality was similar in the HIV-positive vs. HIV-negative groups (26.7% vs. 32.1%; p=0.16), but in those under 60 years of age HIV-positive status was associated with increased mortality (21.3% vs. 9.6%; p<0.001 [log-rank test]). Mortality was higher among people with HIV after adjusting for age (adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.01-2.14; p=0.05), and the association persisted after adjusting for the other variables (aHR 1.69; 95% CI 1.15-2.48; p=0.008) and when restricting the analysis to people aged <60 years (aHR 2.87; 95% CI 1.70-4.84; p<0.001). CONCLUSIONS: HIV-positive status was associated with an increased risk of day-28 mortality among patients hospitalized for COVID-19.
Geretti , A M , Stockdale , A J , Kelly , S H , Cevik , M , Collins , S , Waters , L , Villa , G , Docherty , A , Harrison , E M , Turtle , L , Openshaw , P J M , Baillie , J K , Sabin , C A & Semple , M G 2020 , ' Outcomes of COVID-19 related hospitalization among people with HIV in the ISARIC WHO Clinical Characterization Protocol (UK) : a prospective observational study ' , Clinical Infectious Diseases , vol. In press , ciaa1605 . https://doi.org/10.1093/cid/ciaa1605
Clinical Infectious Diseases
Copyright © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact firstname.lastname@example.org
DescriptionThe work was supported by grants from: the National Institute of Health Research [award COCIN-01]; the Medical Research Council [grant MC_PC_19059]; the National Institute of Health Research Health Protection Research Units (HPRU) in i) Emerging and Zoonotic Infections [NIHR200907] at University of Liverpool in partnership with Public Health England (PHE) and in collaboration with the Liverpool School of Tropical Medicine and the University of Oxford, and ii) Blood Borne and Sexually Transmitted Infections at University College London UCL in partnership with PHE and in collaboration with the London School of Hygiene and Tropical Medicine; the Wellcome Trust and the Department for International Development [215091/Z/18/Z], and the Bill and Melinda Gates Foundation [OPP1209135]. AS is supported by a National Institute of Health Research (NIHR) Academic Clinical Lectureship at the University of Liverpool. LT is supported by the Wellcome Trust [grant number 205228/Z/16/Z]. The Liverpool Experimental Cancer Medicine Centre provided infrastructure support for this research [C18616/A25153].
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