Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
Lancet HIV. 2021 Jan;8(1):e24-e32. doi: 10.1016/S2352-3018(20)30305-2. Epub 2020 Dec 11.
Whether HIV infection is associated with risk of death due to COVID-19 is unclear. We aimed to investigate this association in a large-scale population-based study in England.
We did a retrospective cohort study. Working on behalf of NHS England, we used the OpenSAFELY platform to analyse routinely collected electronic primary care data linked to national death registrations. We included all adults (aged ≥18 years) alive and in follow-up on Feb 1, 2020, and with at least 1 year of continuous registration with a general practitioner before this date. People with a primary care record for HIV infection were compared with people without HIV. The outcome was COVID-19 death, defined as the presence of International Classification of Diseases 10 codes U07.1 or U07.2 anywhere on the death certificate. Cox regression models were used to estimate the association between HIV infection and COVID-19 death; they were initially adjusted for age and sex, then we added adjustment for index of multiple deprivation and ethnicity, and then for a broad range of comorbidities. Interaction terms were added to assess effect modification by age, sex, ethnicity, comorbidities, and calendar time.
17 282 905 adults were included, of whom 27 480 (0·16%) had HIV recorded. People living with HIV were more likely to be male, of Black ethnicity, and from a more deprived geographical area than the general population. 14 882 COVID-19 deaths occurred during the study period, with 25 among people with HIV. People living with HIV had higher risk of COVID-19 death than those without HIV after adjusting for age and sex: hazard ratio (HR) 2·90 (95% CI 1·96-4·30; p<0·0001). The association was attenuated, but risk remained high, after adjustment for deprivation, ethnicity, smoking and obesity: adjusted HR 2·59 (95% CI 1·74-3·84; p<0·0001). There was some evidence that the association was larger among people of Black ethnicity: HR 4·31 (95% CI 2·42-7·65) versus 1·84 (1·03-3·26) in non-Black individuals (p-interaction=0·044).
People with HIV in the UK seem to be at increased risk of COVID-19 mortality. Targeted policies should be considered to address this raised risk as the pandemic response evolves.
Wellcome, Royal Society, National Institute for Health Research, National Institute for Health Research Oxford Biomedical Research Centre, UK Medical Research Council, Health Data Research UK.
HIV 感染是否与 COVID-19 死亡风险相关尚不清楚。我们旨在通过在英格兰的一项大规模基于人群的研究中对此进行研究。
我们进行了回顾性队列研究。代表 NHS 英格兰，我们使用 OpenSAFELY 平台分析了与国家死亡登记相关的常规收集的电子初级保健数据。我们纳入了所有在 2020 年 2 月 1 日存活且正在随访的成年人（年龄≥18 岁），并且在此日期之前至少有 1 年的全科医生连续登记。有初级保健记录的 HIV 感染者与没有 HIV 的人进行了比较。COVID-19 死亡的结局定义为死亡证明上存在国际疾病分类第 10 编码 U07.1 或 U07.2。Cox 回归模型用于估计 HIV 感染与 COVID-19 死亡之间的关联；最初按年龄和性别进行调整，然后按多个剥夺指数和种族进行调整，然后按广泛的合并症进行调整。添加交互项以评估年龄、性别、种族、合并症和日历时间的效应修饰。
纳入了 17282905 名成年人，其中 27480 人（0.16%）有 HIV 记录。与一般人群相比，HIV 感染者更有可能是男性、黑人，并且来自较贫困的地区。在研究期间发生了 14882 例 COVID-19 死亡，其中 25 例发生在 HIV 感染者中。与没有 HIV 的人相比，HIV 感染者在调整年龄和性别后 COVID-19 死亡的风险更高：风险比（HR）为 2.90（95%CI 1.96-4.30；p<0.0001）。在调整剥夺程度、种族、吸烟和肥胖后，关联减弱，但风险仍然很高：调整后的 HR 为 2.59（95%CI 1.74-3.84；p<0.0001）。有一些证据表明，这种关联在黑人中更大：HR 为 4.31（95%CI 2.42-7.65），而非黑人中为 1.84（1.03-3.26）（p 交互=0.044）。
英国的 HIV 感染者似乎 COVID-19 死亡率更高。随着大流行应对措施的发展，应考虑制定有针对性的政策来解决这一高风险问题。
惠康基金会、皇家学会、英国国家卫生研究院、英国国家卫生研究院牛津生物医学研究中心、英国医学研究理事会、英国健康数据研究中心。
