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Impact of HIV on COVID-19 outcomes among hospitalized adults in the United States

Title
Impact of HIV on COVID-19 outcomes among hospitalized adults in the United States
Presenter
Matthew S. Durstenfeld
Authors
M.S. Durstenfeld * (1), K. Sun (2), Y. Ma (2), F. Rodriguez (3), E.A. Secemsky (4,5), R.V. Parikh (6), P.Y. Hsue (1)
Institutions
(1) University of California, San Francisco and Zuckerberg San Francisco General Hospital, Division of Cardiology, San Francisco, United States, (2) University of California, San Francisco, Medicine, San Francisco, United States, (3) Stanford University, Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford, United States, (4) Smith Center for Outcomes Research in Cardiology; Beth Israel Deaconess Medical Center, Department of Medicine, Division of Cardiology, Boston, United States, (5) Harvard Medical School, Boston, United States, (6) University of California, Los Angeles, David Geffen School of Medicine, Division of Cardiology, Los Angeles, United States

BACKGROUND: Whether HIV infection is associated with differences in clinical outcomes among people hospitalized with COVID-19 is uncertain. Therefore, the objective of this study was to evaluate the impact of HIV infection on COVID-19 outcomes among hospitalized patients.
METHODS: This cohort study included all adults hospitalized with COVID-19 from March-December 2020 at 107 hospitals in the US participating in the American Heart Association's COVID-19 Cardiovascular Disease Registry. The primary exposure was HIV status, and the primary outcome was in-hospital mortality. We used hierarchical mixed effects models to assess the association of HIV with in-hospital mortality accounting for patient demographics and comorbidities and clustering by hospital. Secondary outcomes included major adverse cardiac events (MACE), severity of illness, and length of stay (LOS).
RESULTS: The registry included 21,528 hospitalization records of people with confirmed COVID-19 from 107 hospitals in 2020, including 220 people living with HIV (PLWH). PLWH were younger (56.0+/-13.0 versus 61.3+/-17.9 years old) and more likely to be male (72.3% vs 52.7%), Non-Hispanic Black (51.4% vs 25.4%), on Medicaid (44.5% vs 24.5), and active tobacco users (12.7% versus 6.5%).

Of the study population, 36 PLWH (16.4%) had in-hospital mortality compared with 3,290 (15.4%) without HIV (unadjusted Risk ratio 1.06, 95%CI 0.79-1.43; risk difference 0.9%, 95%CI -4.2 to 6.1%; p=0.71). After adjustment for age, sex, race, and insurance, HIV was not associated with in-hospital mortality (aOR 1.13, 95%CI 0.77-1.6; p 0.54) even after adding body mass index and comorbidities (aOR 1.15, 95%CI 0.78-1.70; p=0.48). HIV was not associated with MACE (aOR 0.99, 95%CI 0.69-1.44; p=0.91), severity of illness (aOR 0.96, 95%CI 0.62-1.50; p=0.86), or LOS (aOR 1.03, 95% CI 0.76-1.66, p=0.21) among adults hospitalized with COVID-19.


CONCLUSIONS: In this registry-based study of over 21,000 people hospitalized for COVID-19, HIV was not associated with adverse outcomes including in-hospital mortality, MACE, or severity of illness.