People living with HIV experienced higher rates of COVID-19 hospitalization and mortality in New York State (NYS) between March 1 and June 7, 2020, according to a retrospective study published in JAMA Network Open.
The study authors provided population-level comparisons using matched data from HIV surveillance, laboratory-confirmed COVID-19 diagnoses, and hospitalization databases to compare COVID-19 diagnoses, hospitalization, and in-hospital death between people living with or without HIV.
Among the 108,062 people living with HIV in NYS during the 3-month period, 2.8% (n=2988; 70.6% men; mean age, 54 years) were also diagnosed with COVID-19. Standardized rate ratio (sRR) adjusted for sex, age, and region of residence showed similar COVID-19 diagnosis rates between people living with and without HIV (sRR, 0.94; 95% CI, 0.91-0.97). However, people with HIV were 1.5 times more likely to be hospitalized (sRR, 1.47; 95% CI, 1.37-1.56) and more likely to die (case fataility rate, 69.28 per 1000 vs 38.70 per 1000; sRR, 1.30; 95% CI, 1.13-1.48) compared to people without HIV.
In a model adjusted for age, region of residence, race/ethnicity, HIV transmission risk, and HIV disease stage, COVID-19 diagnosis rates were significantly higher among people with HIV who were 40 to 59 years (adjusted RR [aRR], 1.39; 95% CI, 1.24-1.54) and 60 years or older (aRR, 2.09; 95% CI, 186-2.35) compared with those younger than 40 years.
In addition, Black individuals were 1.6 times more likely (aRR, 1.59; 95% CI, 1.40-1.81) and Hispanic individuals were 2.1 times more likely (aRR, 2.08; 95% CI, 1.83-2.37) to receive a COVID-19 diagnosis compared with White individuals. However, the risk of hospitalization and death were similar between the groups once diagnosed.
Compared with HIV disease stage 1 (CD4 count, ≥500 cells/mm3), people with HIV disease stage 2 (CD4 count, 200-499 cells/mm3) were 1.3 times more likely to be hospitalized with COVID-19 (aRR, 1.29; 95% CI, 1.11-1.49); people with HIV disease stage 3 (CD4 count, <200 cells/mm3) were 1.7 times more likely to be hospitalized (aRR, 1.69; 95% CI, 1.38-2.07). Nevertheless, “CD4 count was not significantly associated with in-hospital death,” the authors noted.
Because the analysis was limited to demographic and laboratory data, the authors were unable to adjust for comorbidities, risk behaviors associated with COVID-19, and societal inequities.
Since HIV was tied to poorer COVID-19 outcomes and may be directly linked, “persons living with diagnosed HIV (with any CD4 count) may warrant recategorization from ‘might be at increased risk’ to ‘increased risk’ in the Centers for Disease Control and Prevention’s underlying medical conditions list,” the authors concluded.
Tesoriero JM, Swain CAE, Pierce JL, et al. COVID-19 outcomes among persons living with or without diagnosed HIV infection in New York State. JAMA Netw Open. 2021;4(2):e2037069. doi:10.1001/jamanetworkopen.2020.37069