Nguyen Vu-Thuy, Nagavedu Kshema, Morrison Monica, Chen Tom, Randall Liisa M, Landazabal Claudia, John Betsey, Klompas Michael, Cocoros Noelle M
Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA.
Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA.
J Acquir Immune Defic Syndr. 2024 Apr 15;95(5):479-485. doi: 10.1097/QAI.0000000000003378.
People with HIV (PWH) may be at risk for more severe COVID-19 outcomes. We compared risk for severe COVID-19 in PWH with matched individuals without HIV.
We identified adults in Massachusetts with a positive SARS-CoV-2 test, March 2020-July 2022, using electronic medical record data from 3 large clinical practice groups. We then used regression models to compare outcomes among PWH versus propensity score-matched people without HIV (matched 20:1) for severe COVID-19 (pneumonia or acute respiratory distress syndrome), hospitalization, and hospital length of stay.
We identified 171,058 individuals with COVID-19; among them, 768 PWH were matched to 15,360 individuals without HIV. Overall, severe COVID-19 and hospitalization were similar in PWH and those without HIV (severe COVID-19: 3.8% vs 3.0%, adjusted odds ratio [OR] 1.27, 95% confidence interval [CI]: 0.86-1.87; hospitalization: 12.1% vs 11.3%, adjusted OR: 1.08, 95% CI: 0.87 to 1.35). Compared with people without HIV, PWH with low CD4 T-cell counts (<200 cells/mm 3 ) had more severe COVID-19 (adjusted OR: 3.99, 95% CI: 2.06 to 7.74) and hospitalization (adjusted OR: 2.26, 95% CI: 1.35 to 3.80), but PWH with high CD4 counts had lower odds of hospitalization (adjusted OR: 0.73, 95% CI: 0.52 to 1.03).
PWH with low CD4 T-cell counts had worse COVID-19 outcomes compared with people without HIV, but outcomes for those with high CD4 counts were similar to, or better than, those without HIV. It is unclear whether these findings are generalizable to settings where PWH have less access to and engagement with health care.
艾滋病病毒感染者（PWH）可能面临更严重的新冠病毒疾病（COVID-19）后果风险。我们比较了艾滋病病毒感染者与匹配的未感染艾滋病病毒个体发生严重COVID-19的风险。
我们利用来自3个大型临床实践组的电子病历数据，确定了2020年3月至2022年7月期间马萨诸塞州SARS-CoV-2检测呈阳性的成年人。然后，我们使用回归模型比较了艾滋病病毒感染者与倾向评分匹配的未感染艾滋病病毒个体（匹配比例为20:1）在发生严重COVID-19（肺炎或急性呼吸窘迫综合征）、住院治疗及住院时长方面的结果。
我们确定了171,058例COVID-19患者；其中，768例艾滋病病毒感染者与15,360例未感染艾滋病病毒个体相匹配。总体而言，艾滋病病毒感染者和未感染艾滋病病毒个体发生严重COVID-19及住院治疗的情况相似（严重COVID-19：3.8%对3.0%，调整后的比值比[OR]为1.27，95%置信区间[CI]：0.86 - 1.87；住院治疗：12.1%对11.3%，调整后的OR：1.08，95% CI：0.87至1.35）。与未感染艾滋病病毒的个体相比，CD4 T细胞计数低（<200个细胞/mm³）的艾滋病病毒感染者发生更严重的COVID-19（调整后的OR：3.99，95% CI：2.06至7.74）及住院治疗的比例更高（调整后的OR：2.26，95% CI：1.35至3.80），但CD4细胞计数高的艾滋病病毒感染者住院几率较低（调整后的OR：0.73，95% CI：0.52至1.03）。
与未感染艾滋病病毒的个体相比，CD4 T细胞计数低的艾滋病病毒感染者COVID-19后果更差，但CD4细胞计数高的感染者的结果与未感染艾滋病病毒的个体相似或更好。尚不清楚这些发现是否适用于艾滋病病毒感染者获得医疗保健机会较少且参与度较低的环境。
