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Same COVID Mortality With/Without HIV
at NY Center--More Intubations With HIV
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AIDS 2020: 23rd International AIDS Conference Virtual, July 6-10, 2020
Mark Mascolini
People admitted to a New York medical center with COVID-19 had the same death rate regardless of HIV status [1]. But people with HIV got intubated more often than non-HIV patients.
The Bronx, New York City's northernmost borough, is a US epicenter of both HIV infection and COVID-19. Of the borough's 1.4 million people, 30% live in poverty, 89% are black or Hispanic, and 35% were born outside the United States. HIV prevalence stands at about 2% in the Bronx. COVID-19 ravaged the Bronx more than any other New York City borough. During the peak of the New York epidemic, in the latter half of March and April 2020, from 200 to more than 300 COVID-19 patients got admitted to Bronx hospitals daily on most days. At the time of this report, 3748 Bronx residents with COVID-19 had died.
Because little is known about potential differences in COVID-19 outcomes with versus without HIV infection, or about the impact of CD4 count and HIV load on coronavirus clinical outcomes, researchers in the Montefiore Health System conducted this study. Montefiore cares for more than 4000 people with HIV at four acute care hospitals and 21 primary care health centers throughout the Bronx.
This analysis included people 18 or older admitted to the hospital between March 10 and May 11, 2020 with RNA PCR positive for SARS-CoV-2, the COVID-19 virus. In statistical analysis of outcomes, potential confounders were age, gender, race/ethnicity, body mass index, history of chronic lower respiratory disease, and date of admission.
The study population consisted of 100 people with HIV and 4513 without HIV. Median ages of the HIV and non-HIV groups were 62 and 65. Proportions of women were 44% and 47%, blacks 43% and 36%, Hispanics 37% and 37%, whites 4% and 8%, and Asian/Pacific islanders 0 and 2.6%. Only 10% in the HIV group and 15% in the non-HIV group had private insurance. A higher proportion with HIV had a history of chronic lower respiratory disease (46% versus 32%), while the HIV group had a lower average body mass index (28.4 versus 29.6 kg/m2).
The groups with or without HIV both stayed in the hospital for a median of 5 days. People with HIV included a higher proportion who had intubation (21% versus 14%, P = 0.051). Adjusted analysis determined that people with HIV had about a 50% higher risk of intubation, but that association stopped just short of statistical significance (adjusted hazard ratio [aHR] 1.54, 95% confidence interval [CI] 0.99 to 2.40, P = 0.055). The same analysis saw no difference between the HIV group and the non-HIV group in time to death or time to hospital discharge. HIV status did not affect risk of acute kidney injury.
Among 96 people with HIV, 81 had a viral load below 40 copies and 15 had a detectable viral load. Adjusted analysis saw a trend toward longer time to discharge in those with a detectable viral load (median 7 versus 5 days) , but that difference missed statistical significance (aHR 1.58, 95% CI 0.97 to 2.55, P = 0.06). No one with a detectable load got intubated or died in the hospital. In comparison, 21 people (26%) with an undetectable load underwent intubation (P = 0.04 versus the detectable group), and 22 people (27%) with an undetectable load died in the hospital (P = 0.02).
Every 100-cell higher CD4 count before admission significantly raised the risk of intubation 14% (aHR 1.14, 95% CI 1.04 to 1.25, P = 0.005). But CD4 count was not associated with death or length of stay.
The Montefiore team noted that their analyses did not control for potential COVID-19 therapy, such as steroids of remdesivir. They concluded that in this largely black and Hispanic COVID-19 population, mostly using public insurance, having HIV infection did not affect chances of death, length of hospital stay, or acute kidney injury. The HIV group did run a higher risk of intubation, in a marginally significant finding (P = 0.055). The researchers proposed that the lack of intubation or death in people with a detectable HIV load "warrants further examination."
Reference
1. 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.
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