Sociodemographic, clinical, and immunological factors associated with SARS-CoV-2 diagnosis and severe COVID-19 outcomes in people living with HIV: a retrospective cohort study
Authors: Daniel K Nomah, Juliana Reyes-Urueña, Yesika Díaz, Sergio Moreno, Jordi Aceiton, Andreu Bruguera, Rosa M Vivanco-Hidalgo, Josep M Llibre, Pere Domingo, Vicenç Falcó, Arkaitz Imaz, Cristina Cortés, Lluís Force, Emili Letang, Ingrid Vilaró, Jordi Casabona, Jose M Miro, Esteve Muntada, Anna Esteve, Melchor Riera, Gemma Navarro, Hernando Knobel, Josep Mallolas, Daniel Podzamczer, Adrià Curran, Joaquín Burgos, Maria Gracia Mateo, Maria del Mar Gutierrez, Javier Murillas, Francisco Homar, Jose Vicente Fernández-Montero, Eva González, Joaquim Peraire, Francesc Vidal, Elena Leon, Àngels Masabeu, Amat-Joaquim Orti, David Dalmau, Àngels Jaen, Elisabet Deig, Elisa De Lazzari, Leire Berrocal, Guillem Fernandez, Lucía Rodríguez, Freya Gargoulas, Toni Vanrell, Jose Carlos Rubia, Josep Vilà, Marina Martínez, Bibiana Morell, Maribel Tamayo, Jorge Palacio, Juan Ambrosioni, Montse Laguno, María Martínez-Rebollar, José Luis Blanco, Felipe Garcia, Esteban Martínez, Berta Torres, Lorena de la Mora, Alexy Inciarte, Ainoa Ugarte, Iván Chivite, Ana González-Cordon, Lorna Leal, Antoni Jou, Maria Saumoy, Ana Silva, Sofia Scévola, Jordi Navarro, Paula Suanzes, Isabel Mur, Maria Àngels Ribas, Antoni A Campins, Francisco Fanjul, María Leyes, María Peñaranda, María Luisa Martin, Helem Haydee Vilchez, Sònia Calzado, Manel Cervantes, M. José Amengual, Marta Navarro, Antoni Payeras, Carmen Cifuentes, Aroa Villoslada, Patrícia Sorní, Marta Molero, Nadia Abdulghani, Thaïs Comella, Rocio Sola, Montserrat Vargas, Consuleo Viladés, Anna Martí, Pilar Barrufet, Laia Arbones, Elena Chamarro, Mireia Cairó, Xavier Martinez-Lacas, Roser Font, Lizza Macorigh
Journal: The Lancet HIV (2021)

BackgroundFactors affecting outcomes of SARS-CoV-2 infection in people living with HIV are unclear. We assessed the factors associated with SARS-CoV-2 diagnosis and severe outcomes among people living with HIV.MethodsWe did a retrospective cohort study using data from the PISCIS cohort of people with HIV in Catalonia (Spain) between March 1 and Dec 15, 2020. We linked PISCIS data with integrated health-care, clinical, and surveillance registries through the Public Data Analysis for Health Research and Innovation Program of Catalonia (PADRIS) to obtain data on SARS-CoV-2 diagnosis, chronic comorbidities, as well as clinical and mortality outcomes. Participants were aged at least 16 years in care at 16 hospitals in Catalonia. Factors associated with SARS-CoV-2 diagnoses and severe outcomes were assessed using univariable and multivariable Cox regression models. We estimated the effect of immunosuppression on severe outcomes (hospital admission for >24 h with dyspnoea, tachypnoea, hypoxaemia, asphyxia, or hyperventilation; or death) using Kaplan-Meier survival analysis.FindingsWe linked 20 847 (72·8%) of 28 666 participants in the PISCIS cohort with PADRIS data; 13 142 people had HIV. 749 (5·7%) people with HIV were diagnosed with SARS-CoV-2: their median age was 43·5 years (IQR 37·0–52·7), 131 (17·5%) were female, and 618 (82·5%) were male. 103 people with HIV (13·8%) were hospitalised, seven (0·9%) admitted to intensive care, and 13 (1·7%) died. SARS-CoV-2 diagnosis was more common among migrants (adjusted hazard ratio 1·55, 95% CI 1·31–1·83), men who have sex with men (1·42, 1·09–1·86), and those with four or more chronic comorbidities (1·46, 1·09–1·97). Age at least 75 years (5·2, 1·8–15·3), non-Spanish origin (2·1, 1·3–3·4), and neuropsychiatric (1·69, 1·07–2·69), autoimmune disease (1·92, 1·14–3·23), respiratory disease (1·84, 1·09–3·09), and metabolic disease (2·59, 1·59–4·23) chronic comorbidities were associated with increased risk of severe outcomes. A Kaplan-Meier estimator showed differences in the risk of severe outcomes according to CD4 cell count in patients with detectable HIV RNA (p=0·039) but no differences were observed in patients with undetectable HIV RNA (p=0·15).InterpretationPeople living with HIV with detectable HIV viraemia, chronic comorbidities, and some subpopulations could be at increased risk of severe outcomes from COVID-19. These groups should be prioritised in clinical management and SARS-CoV-2 vaccination programmes.FundingFundació "la Caixa".TranslationsFor the Catalan, Spanish and Russian translations of the Summary see Supplementary Materials section.