Outcomes of COVID-19 related hospitalization among people with HIV in the ISARIC WHO Clinical Characterization Protocol (UK): a prospective observational study

Anna Maria Geretti; Alexander J Stockdale; Sophie H Kelly; Muge Cevik; Simon Collins; Laura Waters; Giovanni Villa; Annemarie Docherty; Ewen M Harrison; Lance Turtle; Peter J M Openshaw; J Kenneth Baillie; Caroline A Sabin; Malcolm G Semple

doi:10.1093/cid/ciaa1605

Outcomes of COVID-19 related hospitalization among people with HIV in the ISARIC WHO Clinical Characterization Protocol (UK): a prospective observational study

Anna Maria Geretti, Alexander J Stockdale, Sophie H Kelly, Muge Cevik, Simon Collins, Laura Waters, Giovanni Villa, Annemarie Docherty, Ewen M Harrison, Lance Turtle, Peter J M Openshaw, J Kenneth Baillie, Caroline A Sabin, Malcolm G Semple

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Abstract

BACKGROUND: Evidence is conflicting about how HIV modulates COVID-19. We compared the presentation characteristics and outcomes of adults with and without HIV who were hospitalized with COVID-19 at 207 centers across the United Kingdom and whose data were prospectively captured by the ISARIC WHO CCP study.

METHODS: We used Kaplan-Meier methods and Cox regression to describe the association between HIV status and day-28 mortality, after separate adjustment for sex, ethnicity, age, hospital acquisition of COVID-19 (definite hospital acquisition excluded), presentation date, ten individual comorbidities, and disease severity at presentation (as defined by hypoxia or oxygen therapy).

RESULTS: Among 47,592 patients, 122 (0.26%) had confirmed HIV infection and 112/122 (91.8%) had a record of antiretroviral therapy. At presentation, HIV-positive people were younger (median 56 versus 74 years; p<0.001) and had fewer comorbidities, more systemic symptoms and higher lymphocyte counts and C-reactive protein levels. The cumulative day-28 mortality was similar in the HIV-positive vs. HIV-negative groups (26.7% vs. 32.1%; p=0.16), but in those under 60 years of age HIV-positive status was associated with increased mortality (21.3% vs. 9.6%; p<0.001 [log-rank test]). Mortality was higher among people with HIV after adjusting for age (adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.01-2.14; p=0.05), and the association persisted after adjusting for the other variables (aHR 1.69; 95% CI 1.15-2.48; p=0.008) and when restricting the analysis to people aged <60 years (aHR 2.87; 95% CI 1.70-4.84; p<0.001).

CONCLUSIONS: HIV-positive status was associated with an increased risk of day-28 mortality among patients hospitalized for COVID-19.

Original language	English
Pages (from-to)	e2095-e2106
Journal	Clinical Infectious Diseases
Volume	73
Issue number	7
Early online date	23 Oct 2020
DOIs	https://doi.org/10.1093/cid/ciaa1605
Publication status	Published - 1 Oct 2021

Keywords

COVID-19
SARS-CoV-2
HIV
Mortality

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/cid/ciaa1605Licence: CC BY

Geretti_2020_CID_OutcomesCovid-19_CC
Copyright © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
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Cite this

Geretti, A. M., Stockdale, A. J., Kelly, S. H., Cevik, M., Collins, S., Waters, L., Villa, G., Docherty, A., Harrison, E. M., Turtle, L., Openshaw, P. J. M., Baillie, J. K., Sabin, C. A., & Semple, M. G. (2021). Outcomes of COVID-19 related hospitalization among people with HIV in the ISARIC WHO Clinical Characterization Protocol (UK): a prospective observational study. Clinical Infectious Diseases, 73(7), e2095-e2106. https://doi.org/10.1093/cid/ciaa1605

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title = "Outcomes of COVID-19 related hospitalization among people with HIV in the ISARIC WHO Clinical Characterization Protocol (UK): a prospective observational study",

abstract = "BACKGROUND: Evidence is conflicting about how HIV modulates COVID-19. We compared the presentation characteristics and outcomes of adults with and without HIV who were hospitalized with COVID-19 at 207 centers across the United Kingdom and whose data were prospectively captured by the ISARIC WHO CCP study.METHODS: We used Kaplan-Meier methods and Cox regression to describe the association between HIV status and day-28 mortality, after separate adjustment for sex, ethnicity, age, hospital acquisition of COVID-19 (definite hospital acquisition excluded), presentation date, ten individual comorbidities, and disease severity at presentation (as defined by hypoxia or oxygen therapy).RESULTS: Among 47,592 patients, 122 (0.26%) had confirmed HIV infection and 112/122 (91.8%) had a record of antiretroviral therapy. At presentation, HIV-positive people were younger (median 56 versus 74 years; p<0.001) and had fewer comorbidities, more systemic symptoms and higher lymphocyte counts and C-reactive protein levels. The cumulative day-28 mortality was similar in the HIV-positive vs. HIV-negative groups (26.7% vs. 32.1%; p=0.16), but in those under 60 years of age HIV-positive status was associated with increased mortality (21.3% vs. 9.6%; p<0.001 [log-rank test]). Mortality was higher among people with HIV after adjusting for age (adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.01-2.14; p=0.05), and the association persisted after adjusting for the other variables (aHR 1.69; 95% CI 1.15-2.48; p=0.008) and when restricting the analysis to people aged <60 years (aHR 2.87; 95% CI 1.70-4.84; p<0.001).CONCLUSIONS: HIV-positive status was associated with an increased risk of day-28 mortality among patients hospitalized for COVID-19.",

keywords = "COVID-19, SARS-CoV-2, HIV, Mortality",

author = "Geretti, {Anna Maria} and Stockdale, {Alexander J} and Kelly, {Sophie H} and Muge Cevik and Simon Collins and Laura Waters and Giovanni Villa and Annemarie Docherty and Harrison, {Ewen M} and Lance Turtle and Openshaw, {Peter J M} and Baillie, {J Kenneth} and Sabin, {Caroline A} and Semple, {Malcolm G}",

note = "The work was supported by grants from: the National Institute of Health Research [award COCIN-01]; the Medical Research Council [grant MC_PC_19059]; the National Institute of Health Research Health Protection Research Units (HPRU) in i) Emerging and Zoonotic Infections [NIHR200907] at University of Liverpool in partnership with Public Health England (PHE) and in collaboration with the Liverpool School of Tropical Medicine and the University of Oxford, and ii) Blood Borne and Sexually Transmitted Infections at University College London UCL in partnership with PHE and in collaboration with the London School of Hygiene and Tropical Medicine; the Wellcome Trust and the Department for International Development [215091/Z/18/Z], and the Bill and Melinda Gates Foundation [OPP1209135]. AS is supported by a National Institute of Health Research (NIHR) Academic Clinical Lectureship at the University of Liverpool. LT is supported by the Wellcome Trust [grant number 205228/Z/16/Z]. The Liverpool Experimental Cancer Medicine Centre provided infrastructure support for this research [C18616/A25153].",

year = "2021",

month = oct,

day = "1",

doi = "10.1093/cid/ciaa1605",

language = "English",

volume = "73",

pages = "e2095--e2106",

journal = "Clinical Infectious Diseases",

issn = "1058-4838",

publisher = "Oxford University Press",

number = "7",

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Geretti, AM, Stockdale, AJ, Kelly, SH, Cevik, M, Collins, S, Waters, L, Villa, G, Docherty, A, Harrison, EM, Turtle, L, Openshaw, PJM, Baillie, JK, Sabin, CA & Semple, MG 2021, 'Outcomes of COVID-19 related hospitalization among people with HIV in the ISARIC WHO Clinical Characterization Protocol (UK): a prospective observational study', Clinical Infectious Diseases, vol. 73, no. 7, pp. e2095-e2106. https://doi.org/10.1093/cid/ciaa1605

Outcomes of COVID-19 related hospitalization among people with HIV in the ISARIC WHO Clinical Characterization Protocol (UK): a prospective observational study. / Geretti, Anna Maria; Stockdale, Alexander J; Kelly, Sophie H et al.
In: Clinical Infectious Diseases, Vol. 73, No. 7, 01.10.2021, p. e2095-e2106.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Outcomes of COVID-19 related hospitalization among people with HIV in the ISARIC WHO Clinical Characterization Protocol (UK)

T2 - a prospective observational study

AU - Geretti, Anna Maria

AU - Stockdale, Alexander J

AU - Kelly, Sophie H

AU - Cevik, Muge

AU - Collins, Simon

AU - Waters, Laura

AU - Villa, Giovanni

AU - Docherty, Annemarie

AU - Harrison, Ewen M

AU - Turtle, Lance

AU - Openshaw, Peter J M

AU - Baillie, J Kenneth

AU - Sabin, Caroline A

AU - Semple, Malcolm G

N1 - The work was supported by grants from: the National Institute of Health Research [award COCIN-01]; the Medical Research Council [grant MC_PC_19059]; the National Institute of Health Research Health Protection Research Units (HPRU) in i) Emerging and Zoonotic Infections [NIHR200907] at University of Liverpool in partnership with Public Health England (PHE) and in collaboration with the Liverpool School of Tropical Medicine and the University of Oxford, and ii) Blood Borne and Sexually Transmitted Infections at University College London UCL in partnership with PHE and in collaboration with the London School of Hygiene and Tropical Medicine; the Wellcome Trust and the Department for International Development [215091/Z/18/Z], and the Bill and Melinda Gates Foundation [OPP1209135]. AS is supported by a National Institute of Health Research (NIHR) Academic Clinical Lectureship at the University of Liverpool. LT is supported by the Wellcome Trust [grant number 205228/Z/16/Z]. The Liverpool Experimental Cancer Medicine Centre provided infrastructure support for this research [C18616/A25153].

PY - 2021/10/1

Y1 - 2021/10/1

N2 - BACKGROUND: Evidence is conflicting about how HIV modulates COVID-19. We compared the presentation characteristics and outcomes of adults with and without HIV who were hospitalized with COVID-19 at 207 centers across the United Kingdom and whose data were prospectively captured by the ISARIC WHO CCP study.METHODS: We used Kaplan-Meier methods and Cox regression to describe the association between HIV status and day-28 mortality, after separate adjustment for sex, ethnicity, age, hospital acquisition of COVID-19 (definite hospital acquisition excluded), presentation date, ten individual comorbidities, and disease severity at presentation (as defined by hypoxia or oxygen therapy).RESULTS: Among 47,592 patients, 122 (0.26%) had confirmed HIV infection and 112/122 (91.8%) had a record of antiretroviral therapy. At presentation, HIV-positive people were younger (median 56 versus 74 years; p<0.001) and had fewer comorbidities, more systemic symptoms and higher lymphocyte counts and C-reactive protein levels. The cumulative day-28 mortality was similar in the HIV-positive vs. HIV-negative groups (26.7% vs. 32.1%; p=0.16), but in those under 60 years of age HIV-positive status was associated with increased mortality (21.3% vs. 9.6%; p<0.001 [log-rank test]). Mortality was higher among people with HIV after adjusting for age (adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.01-2.14; p=0.05), and the association persisted after adjusting for the other variables (aHR 1.69; 95% CI 1.15-2.48; p=0.008) and when restricting the analysis to people aged <60 years (aHR 2.87; 95% CI 1.70-4.84; p<0.001).CONCLUSIONS: HIV-positive status was associated with an increased risk of day-28 mortality among patients hospitalized for COVID-19.

AB - BACKGROUND: Evidence is conflicting about how HIV modulates COVID-19. We compared the presentation characteristics and outcomes of adults with and without HIV who were hospitalized with COVID-19 at 207 centers across the United Kingdom and whose data were prospectively captured by the ISARIC WHO CCP study.METHODS: We used Kaplan-Meier methods and Cox regression to describe the association between HIV status and day-28 mortality, after separate adjustment for sex, ethnicity, age, hospital acquisition of COVID-19 (definite hospital acquisition excluded), presentation date, ten individual comorbidities, and disease severity at presentation (as defined by hypoxia or oxygen therapy).RESULTS: Among 47,592 patients, 122 (0.26%) had confirmed HIV infection and 112/122 (91.8%) had a record of antiretroviral therapy. At presentation, HIV-positive people were younger (median 56 versus 74 years; p<0.001) and had fewer comorbidities, more systemic symptoms and higher lymphocyte counts and C-reactive protein levels. The cumulative day-28 mortality was similar in the HIV-positive vs. HIV-negative groups (26.7% vs. 32.1%; p=0.16), but in those under 60 years of age HIV-positive status was associated with increased mortality (21.3% vs. 9.6%; p<0.001 [log-rank test]). Mortality was higher among people with HIV after adjusting for age (adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.01-2.14; p=0.05), and the association persisted after adjusting for the other variables (aHR 1.69; 95% CI 1.15-2.48; p=0.008) and when restricting the analysis to people aged <60 years (aHR 2.87; 95% CI 1.70-4.84; p<0.001).CONCLUSIONS: HIV-positive status was associated with an increased risk of day-28 mortality among patients hospitalized for COVID-19.

KW - COVID-19

KW - SARS-CoV-2

KW - HIV

KW - Mortality

UR - https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1605/5937133#supplementary-data

U2 - 10.1093/cid/ciaa1605

DO - 10.1093/cid/ciaa1605

M3 - Article

C2 - 33095853

SN - 1058-4838

VL - 73

SP - e2095-e2106

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - 7

ER -

Outcomes of COVID-19 related hospitalization among people with HIV in the ISARIC WHO Clinical Characterization Protocol (UK): a prospective observational study

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