HIV does not increase risk for COVID-19 hospitalization
Among people with HIV and COVID-19, researchers linked noncommunicable comorbidities, such as diabetes and cardiovascular disease, as opposed to HIV alone, with an increased risk for hospitalization, according to a study presented at IDWeek.
In a retrospective chart review, Michael D. Virata, MD, FACP, assistant professor of medicine at Yale University School of Medicine, and colleagues assessed patients with HIV who were diagnosed with COVID-19 and received care at a single academic HIV ambulatory center from March to July 2020. All patients were symptomatic and had a confirmed diagnosis of COVID-19 based on real-time RT-PCR.
The study included 48 patients — of whom 19 were hospitalized because of COVID-19. The median age was 56 years, 52% were women, 67% were aged 50 years or older and 62.5% were African American.
For the study cohort overall, the average length of time that patients lived with HIV was 14 years, which was only slightly lower than the average of 15 years for patients who were hospitalized because of COVID-19. The percentage of patients with an AIDS diagnosis was higher than that of the overall cohort, but the difference was not statistically significant, Virata noted during an oral abstract presentation. Additionally, there were no significant differences in prescription of ART, median CD4 count and percentage of those with a suppressed viral load of less than 200 copies/mL between all study patients and those who were hospitalized.
Comorbid conditions were common among all patients in the study cohort, including hypertension (50%), underlying chronic lung disease (39.6%), cardiovascular disease (39.6%), obesity (45.8%), chronic kidney disease (22.9%) and diabetes (29.2%), with approximately two-thirds having more than one comorbidity, according to Virata.
The researchers identified several factors that were significantly associated with the need for hospitalization, including age 50 years or older (OR = 1.6; 95% CI, 1.1-2.5), diabetes (OR = 2; 95% CI, 0.95-4.1), cardiovascular disease (OR = 2.5; 95% CI, 1.3-5) and multiple comorbidities (OR = 1.9; 95% CI, 1.2-2.8).
“We learned from our unique cohort of people with HIV that they have common comorbidities that place them at risk for hospitalization and were similar when compared with HIV-negative patients reported in other studies,” Virata said during the virtual presentation.
Furthermore, with regard to HIV markers, patients in this study maintained excellent viral suppression but did suffer decline in CD4 counts because of the acute illness and its effects on lymphocyte counts, Virata noted. Patients’ antiretroviral regimens were continued without switching to other drug classes, such as protease inhibitors, that were initially recommended as part of treatment algorithms.
Approximately 21% of patients required additional step-up care, although no patients died within 30 days after diagnosis.
“With the advancement of ART, people with HIV are living longer and are increasingly diagnosed with new or multiple comorbidities, particularly among our communities of color. Therefore, while HIV immunosuppression was not associated with an increased risk for COVID-19-related hospitalization, the indirect measures of HIV and aging as manifested by comorbidities did correlate with hospitalization for COVID-19,” Virata said.
“Overall, we were encouraged by the good short-term outcomes. However, we still need to understand some of the long-term morbidity and mortality possibilities for people with HIV and COVID-19.”
Virata noted that the study was not without limitations, including its single-center design, lack of widespread testing for COVID-19 and the fact that only symptomatic patients were tested early in the pandemic.
Virata also said the patients in this study had access to a variety of experimental treatments and elevated level of care — interventions that may not be available or replicated in other health care settings — that may account for more favorable outcomes.