Risk Factors for SARS-CoV-2 Infection and Severe Outcomes Among People With Human Immunodeficiency Virus: Cohort Study

John J Hanna; Liyu B Geresu; Marlon I Diaz; Milan Ho; Julia A Casazza; Madison A Pickering; Heather D Lanier; Alexander P Radunsky; Lauren N Cooper; Sameh N Saleh; Roger J Bedimo; Zachary M Most; Trish M Perl; Christoph U Lehmann; Robert W Turer; Jeremy Y Chow; Richard J Medford

doi:10.1093/ofid/ofad400

Risk Factors for SARS-CoV-2 Infection and Severe Outcomes Among People With Human Immunodeficiency Virus: Cohort Study

Open Forum Infect Dis. 2023 Jul 24;10(8):ofad400. doi: 10.1093/ofid/ofad400. eCollection 2023 Aug.

Authors

John J Hanna^{1

2}, Liyu B Geresu^{2

3}, Marlon I Diaz², Milan Ho¹, Julia A Casazza¹, Madison A Pickering², Heather D Lanier¹, Alexander P Radunsky¹, Lauren N Cooper², Sameh N Saleh², Roger J Bedimo¹, Zachary M Most⁴, Trish M Perl¹, Christoph U Lehmann^{2

4

5

6}, Robert W Turer^{2

7}, Jeremy Y Chow¹, Richard J Medford^{1

2}

Affiliations

¹ Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
² Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
³ Healthcare Informatics, Children's Health Hospitals and Health Care, Dallas, Texas, USA.
⁴ Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA.
⁵ Lyda Hill Department of Bioinformatics, UT Southwestern Medical Center, Dallas, Texas, USA.
⁶ Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA.
⁷ Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.

Abstract

Background: Studies on COVID-19 in people with HIV (PWH) have had limitations. Further investigations on risk factors and outcomes of SARS-CoV-2 infection among PWH are needed.

Methods: This retrospective cohort study leveraged the national OPTUM COVID-19 data set to investigate factors associated with SARS-CoV-2 positivity among PWH and risk factors for severe outcomes, including hospitalization, intensive care unit stays, and death. A subset analysis was conducted to examine HIV-specific variables. Multiple variable logistic regression was used to adjust for covariates.

Results: Of 43 173 PWH included in this study, 6472 had a positive SARS-CoV-2 result based on a polymerase chain reaction test or antigen test. For PWH with SARS-CoV-2 positivity, higher odds were found for those who were younger (18-49 years), Hispanic White, African American, from the US South, uninsured, and a noncurrent smoker and had a higher body mass index and higher Charlson Comorbidity Index. For PWH with severe outcomes, higher odds were identified for those who were SARS-CoV-2 positive, older, from the US South, receiving Medicaid/Medicare or uninsured, a current smoker, and underweight and had a higher Charlson Comorbidity Index. In a subset analysis including PWH with HIV care variables (n = 5098), those with unsuppressed HIV viral load, a low CD4 count, and no antiretroviral therapy had higher odds of severe outcomes.

Conclusions: This large US study found significant ethnic, racial, and geographic differences in SARS-CoV-2 infection among PWH. Chronic comorbidities, older age, lower body mass index, and smoking were associated with severe outcomes among PWH during the COVID-19 pandemic. SARS-CoV-2 infection was associated with severe outcomes, but once we adjusted for HIV care variables, SARS-CoV-2 was no longer significant; however, low CD4 count, high viral load, and lack of antiretroviral therapy had higher odds of severe outcomes.

Keywords: COVID-19; SARS-CoV-2; electronic health records; human immunodeficiency virus; risk factors.