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COVID-19 Rate No Higher With HIV in Largest US HIV+/HIV- Cohort
  AIDS 2020: 23rd International AIDS Conference Virtual, July 6-10, 2020
Mark Mascolini
US veterans with HIV infection did not run a higher risk of COVID-19 than veterans without HIV in a 7576-person analysis [1]. And severe COVID-19 outcomes--including intubation and death--did not prove more likely in veterans with HIV.
People with subpar immune function, like those with HIV infection, may run a risk of worse COVID-19 outcomes than people with a healthy immune system. Comparisons of COVID-19 susceptibility and outcomes with versus without HIV have only begun to appear in the last several weeks. At AIDS 2020, for example, a 4600-person comparison of COVID-19 patients with and without HIV in the Bronx, New York, found similar mortality in the two groups but higher intubation rates with HIV [2].
A new comparison of COVID-19 outcomes in people with HIV involved the Veterans Aging Cohort Study (VACS), the largest HIV cohort in the United States. VACS enrolls all veterans with HIV and matches each of them to 2 HIV-negative veterans by age, sex, race/ethnicity, and VACS site. VACS investigators analyzed data from their cohort to determine whether rates of COVID-19 testing, positivity, or outcomes differ by HIV status.
The VACS team set the baseline date for each cohort member as the date of SARS-CoV-2 specimen collection, hospital admission, or reported external testing. They used logistic regression adjusted for age, sex, race/ethnicity, body mass index, alcohol consumption, and smoking to estimate associations between baseline variables and COVID-19 testing. Cox proportional hazards regression adjusted for age, sex, and race/ethnicity estimated associations between HIV status and severe COVID-19.
The baseline study group included 253 HIV+/COVID+ veterans, 2346 HIV+/COVID- veterans, 504 HIV-/COVID+ veterans, and 4473 HIV-/COVID- veterans. Across those four groups, proportions of blacks were 62.1%, 50.6%, 61.3%, and 54.6%, Hispanics 7.9%, 9.3%, 10.3%, and 8.6%, men 99.2%, 96.2%, 97.2%, and 96.5%, hazardous drinkers 13%, 21%, 13.7%, and 23.1%, and current smokers 43.5%, 53.5%, 38.1%, and 53.9%.
Through 113 days of follow-up, 8.4% of veterans with HIV versus 6.5% of HIV-negative veterans got tested for COVID-19 or reported a COVID-19 diagnosis, meaning the HIV group had about a one-third higher chance of getting tested for coronavirus infection (adjusted odds ratio [aOR] 1.36, 95% confidence interval 1.29 to 1.43). But the proportion of positive results among those tested for COVID-19 was similar with and without HIV (9.7% and 10.1%, aOR 1.05, 95% CI 0.89 to 1.24). Compared with white veterans, blacks had 70% higher odds of a positive COVID-19 test (aOR 1.70, 95% CI 1.41 to 2.05) and Hispanics had 43% higher odds (aOR 1.43, 95% CI 1.06 to 1.92). But higher odds for blacks and Hispanics did not differ by HIV status.
Among veterans with COVID-19, those with HIV did not differ from the HIV-negative group in risk of hospital admission (adjusted hazard ratio [aHR] 1.09, 95% CI 0.85 to 1.41), intensive care unit admission (aHR 1.08, 95% CI 0.72 to 1.62), intubation (aHR 0.89, 95% CI 0.49 to 1.59), or death (aHR 1.08, 95% CI 0.66 to 1.75).
VACS investigators conclude that although US veterans with HIV got tested for COVID-19 more than HIV-negative veterans, among those tested a similar proportion of HIV-positive and negative veterans got diagnosed with COVID-19. The VACS team suggests their results could be affected by SARS-CoV-2 test shortages and differences between HIV-positive and negative veterans in adhering to stay-at-home orders. The overwhelming proportion of men in VACS means these findings may not apply to women with HIV or COVID-19.
The researchers also caution that demographic matching of HIV-positive and negative veterans in VACS "inherently adjusts for important confounders" in COVID-19 analyses. Cohort comparisons that do not adjust for age, race, sex, and location may find different results.
1. Park LS, Rentsch CT, Sigel K, et al. COVID-19 in the largest US HIV cohort. AIDS 2020: 23rd International AIDS Conference Virtual. July 6-10, 2020. Abstract LBPEC23.
2. Patel VV, Felsen UR, Fisher M, et al. Clinical outcomes by HIV serostatus, CD4 count, and viral suppression among people hospitalized with COVID-19 in the Bronx, New York. AIDS 2020: 23rd International AIDS Conference Virtual. July 6-10, 2020. Abstract OABLB0102.