South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; Big Data Health Science Center, University of South Carolina, Columbia, SC, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Lancet HIV. 2021 Nov;8(11):e690-e700. doi: 10.1016/S2352-3018(21)00239-3. Epub 2021 Oct 13.
Evidence of whether people living with HIV are at elevated risk of adverse COVID-19 outcomes is inconclusive. We aimed to investigate this association using the population-based National COVID Cohort Collaborative (N3C) data in the USA.
We included all adult (aged ≥18 years) COVID-19 cases with any health-care encounter from 54 clinical sites in the USA, with data being deposited into the N3C. The outcomes were COVID-19 disease severity, hospitalisation, and mortality. Encounters in the same health-care system beginning on or after January 1, 2018, were also included to provide information about pre-existing health conditions (eg, comorbidities). Logistic regression models were employed to estimate the association of HIV infection and HIV markers (CD4 cell count, viral load) with hospitalisation, mortality, and clinical severity of COVID-19 (multinomial). The models were initially adjusted for demographic characteristics, then subsequently adjusted for smoking, obesity, and a broad range of comorbidities. Interaction terms were added to assess moderation effects by demographic characteristics.
In the harmonised N3C data release set from Jan 1, 2020, to May 8, 2021, there were 1 436 622 adult COVID-19 cases, of these, 13 170 individuals had HIV infection. A total of 26 130 COVID-19 related deaths occurred, with 445 among people with HIV. After adjusting for all the covariates, people with HIV had higher odds of COVID-19 death (adjusted odds ratio 1·29, 95% CI 1·16-1·44) and hospitalisation (1·20, 1·15-1·26), but lower odds of mild or moderate COVID-19 (0·61, 0·59-0·64) than people without HIV. Interaction terms revealed that the elevated odds were higher among older age groups, male, Black, African American, Hispanic, or Latinx adults. A lower CD4 cell count (<200 cells per μL) was associated with all the adverse COVID-19 outcomes, while viral suppression was only associated with reduced hospitalisation.
Given the COVID-19 pandemic's exacerbating effects on health inequities, public health and clinical communities must strengthen services and support to prevent aggravated COVID-19 outcomes among people with HIV, particularly for those with pronounced immunodeficiency.
National Center for Advancing Translational Sciences, National Institute of Allergy and Infectious Diseases, National Institutes of Health, USA.
目前尚不清楚 HIV 感染者是否面临更高的 COVID-19 不良结局风险。本研究旨在使用美国基于人群的国家 COVID 队列协作（N3C）数据对此进行研究。
我们纳入了美国 54 个临床站点中所有有任何医疗保健接触的成年（≥18 岁）COVID-19 病例，数据被存入 N3C。结局为 COVID-19 疾病严重程度、住院和死亡。纳入了自 2018 年 1 月 1 日或之后在同一医疗系统开始的接触，以提供有关先前存在的健康状况（例如合并症）的信息。使用逻辑回归模型估计 HIV 感染和 HIV 标志物（CD4 细胞计数、病毒载量）与 COVID-19 住院、死亡和临床严重程度（多项）的关联。模型最初按人口统计学特征进行调整，然后按吸烟、肥胖和广泛的合并症进行调整。添加交互项以评估人口统计学特征的调节作用。
在 2020 年 1 月 1 日至 2021 年 5 月 8 日的 N3C 数据协调发布集中，共有 1436622 例成年 COVID-19 病例，其中 13170 例有 HIV 感染。共有 26130 例 COVID-19 相关死亡，其中 445 例发生在 HIV 感染者中。在调整所有协变量后，HIV 感染者 COVID-19 死亡的可能性更高（调整后的比值比 1.29，95%CI 1.16-1.44）和住院（1.20，1.15-1.26），但轻度或中度 COVID-19 的可能性较低（0.61，0.59-0.64）比没有 HIV 的人。交互项表明，年龄较大、男性、黑人、非裔美国人、西班牙裔或拉丁裔成年人的风险增加更高。较低的 CD4 细胞计数（<200 个细胞/μL）与所有不良 COVID-19 结局相关，而病毒抑制仅与减少住院相关。
鉴于 COVID-19 大流行对健康不平等的加剧影响，公共卫生和临床界必须加强服务和支持，以防止 HIV 感染者 COVID-19 结局恶化，特别是对于那些免疫缺陷明显的患者。
美国国家转化科学促进中心、美国国立过敏和传染病研究所、美国国立卫生研究院。
