University of California San Diego, San Diego, California, USA.
Sansum Clinic, Santa Barbara, California, USA.
HIV Med. 2022 Nov;23(10):1069-1077. doi: 10.1111/hiv.13312. Epub 2022 Apr 8.
We investigated the effect of HIV on COVID-19 outcomes with attention to selection bias due to differential testing and comorbidity burden.
This was a retrospective cohort analysis using four hierarchical outcomes: positive SARS-CoV-2 test, COVID-19 hospitalization, intensive care unit (ICU) admission and hospital mortality. The effect of HIV status was assessed using traditional covariate-adjusted, inverse probability-weighted (IPW) analysis based on covariate distributions for testing bias (testing IPWs), HIV infection status (HIV-IPWs) and combined models. Among people living with HIV (PWH), we evaluated whether CD4 count and HIV plasma viral load (pVL) discriminated between those who did and those who did not develop study outcomes using receiver operating characteristic analysis.
Between March and November 2020, 63 319 people were receiving primary care services at the University of California San Diego (UCSD), of whom 4017 were PWH. The PWH had 2.1 times the odds of a positive SARS-CoV-2 test compared with those without HIV after weighting for potential testing bias, comorbidity burden and HIV-IPW [95% confidence interval (CI): 1.6-2.8]. Relative to people without HIV, PWH did not have an increased rate of COVID-19 hospitalization after controlling for comorbidities and testing bias [adjusted incidence rate ratio (aIRR) = 0.5, 95% CI: 0.1-1.4]. PWH did not have a different rate of ICU admission (aIRR = 1.08, 95% CI: 0.31-3.80) or of in-hospital death (aIRR = 0.92, 95% CI: 0.08-10.94) in any examined model. Neither CD4 count nor pVL predicted any of the hierarchical outcomes among PWH.
People living with HIV have a higher risk of COVID-19 diagnosis than those without HIV but the outcomes are similar in both groups.
我们研究了 HIV 对 COVID-19 结局的影响，特别关注由于检测和合并症负担的差异导致的选择偏倚。
这是一项回顾性队列分析，使用四个分层结局：SARS-CoV-2 检测阳性、COVID-19 住院、重症监护病房（ICU）入院和住院死亡率。使用传统的协变量调整、逆概率加权（IPW）分析评估 HIV 状态的影响，该分析基于检测偏倚（检测 IPW）、HIV 感染状态（HIV-IPW）和综合模型的协变量分布。在 HIV 感染者（PLWH）中，我们使用受试者工作特征分析评估 CD4 计数和 HIV 血浆病毒载量（pVL）是否能区分出现和未出现研究结局的患者。
在 2020 年 3 月至 11 月期间，加利福尼亚大学圣地亚哥分校（UCSD）有 63319 人接受初级保健服务，其中 4017 人为 PLWH。在加权考虑潜在检测偏倚、合并症负担和 HIV-IPW 后，PLWH 检测 SARS-CoV-2 阳性的几率是无 HIV 感染者的 2.1 倍[95%置信区间（CI）：1.6-2.8]。在控制合并症和检测偏倚后，与无 HIV 感染者相比，PLWH 的 COVID-19 住院率并没有增加[校正发病率比（aIRR）=0.5，95%CI：0.1-1.4]。在任何检查模型中，PLWH 的 ICU 入院率（aIRR=1.08，95%CI：0.31-3.80）或住院死亡率（aIRR=0.92，95%CI：0.08-10.94）均无差异。CD4 计数和 pVL 均不能预测 PLWH 的任何分层结局。
与无 HIV 感染者相比，HIV 感染者 COVID-19 诊断的风险更高，但两组患者的结局相似。
