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Is there an association between prior diagnosis of HIV infection and coronavirus disease 2019 (COVID-19) diagnosis, hospitalization, and in-hospital death among residents of New York State?
In a cohort study of linked statewide HIV diagnosis, COVID-19 laboratory diagnosis, and hospitalization databases, persons living with an HIV diagnosis were more likely to receive a diagnosis of, be hospitalized with, and die in-hospital with COVID-19 compared with those not living with an HIV diagnosis. After demographic adjustment, COVID-19 hospitalization remained significantly elevated for individuals with an HIV diagnosis and was associated with elevated mortality.
Persons living with an HIV diagnosis experienced poorer COVID-related outcomes (principally, higher rates of severe disease requiring hospitalization) relative to those without an HIV diagnosis.
New York State has been an epicenter for both the US coronavirus disease 2019 (COVID-19) and HIV/AIDS epidemics. Persons living with diagnosed HIV may be more prone to COVID-19 infection and severe outcomes, yet few studies have assessed this possibility at a population level.
To evaluate the association between HIV diagnosis and COVID-19 diagnosis, hospitalization, and in-hospital death in New York State.
Design, Setting, and Participants
This cohort study, conducted in New York State, including New York City, between March 1 and June 15, 2020, matched data from HIV surveillance, COVID-19 laboratory-confirmed diagnoses, and hospitalization databases to provide a full population-level comparison of COVID-19 outcomes between persons living with diagnosed HIV and persons living without diagnosed HIV.
Diagnosis of HIV infection through December 31, 2019.
Main Outcomes and Measures
The main outcomes were COVID-19 diagnosis, hospitalization, and in-hospital death. COVID-19 diagnoses, hospitalizations, and in-hospital death rates comparing persons living with diagnosed HIV with persons living without dianosed HIV were computed, with unadjusted rate ratios and indirect standardized rate ratios (sRR), adjusting for sex, age, and region. Adjusted rate ratios (aRRs) for outcomes specific to persons living with diagnosed HIV were assessed by age, sex, region, race/ethnicity, transmission risk, and CD4+ T-cell count–defined HIV disease stage, using Poisson regression models.
A total of 2988 persons living with diagnosed HIV (2109 men [70.6%]; 2409 living in New York City [80.6%]; mean [SD] age, 54.0 [13.3] years) received a diagnosis of COVID-19. Of these persons living with diagnosed HIV, 896 were hospitalized and 207 died in the hospital through June 15, 2020. After standardization, persons living with diagnosed HIV and persons living without diagnosed HIV had similar diagnosis rates (sRR, 0.94 [95% CI, 0.91-0.97]), but persons living with diagnosed HIV were hospitalized more than persons living without diagnosed HIV, per population (sRR, 1.38 [95% CI, 1.29-1.47]) and among those diagnosed (sRR, 1.47 [95% CI, 1.37-1.56]). Elevated mortality among persons living with diagnosed HIV was observed per population (sRR, 1.23 [95% CI, 1.07-1.40]) and among those diagnosed (sRR, 1.30 [95% CI, 1.13-1.48]) but not among those hospitalized (sRR, 0.96 [95% CI, 0.83-1.09]). Among persons living with diagnosed HIV, non-Hispanic Black individuals (aRR, 1.59 [95% CI, 1.40-1.81]) and Hispanic individuals (aRR, 2.08 [95% CI, 1.83-2.37]) were more likely to receive a diagnosis of COVID-19 than White individuals, but they were not more likely to be hospitalized once they received a diagnosis or to die once hospitalized. Hospitalization risk increased with disease progression to HIV stage 2 (aRR, 1.29 [95% CI, 1.11-1.49]) and stage 3 (aRR, 1.69 [95% CI, 1.38-2.07]) relative to stage 1.
Conclusions and Relevance
In this cohort study, persons living with diagnosed HIV experienced poorer COVID-related outcomes relative to persons living without diagnosed HIV; Previous HIV diagnosis was associated with higher rates of severe disease requiring hospitalization, and hospitalization risk increased with progression of HIV disease stage.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: December 19, 2020.
Published: February 3, 2021. doi:10.1001/jamanetworkopen.2020.37069
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Tesoriero JM et al. JAMA Network Open.
Corresponding Author: Eli S. Rosenberg, PhD, Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, One University Pl, Room 123, Rensselaer, NY 12144 (email@example.com).
Author Contributions: Drs Tesoriero and Swain had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Tesoriero, Swain, Holtgrave, Gonzalez, Udo, Morne, Hart-Malloy, Rajulu, Leung, Rosenberg.
Acquisition, analysis, or interpretation of data: Tesoriero, Swain, Pierce, Zamboni, Wu, Gonzalez, Udo, Rosenberg.
Drafting of the manuscript: Tesoriero, Swain, Pierce, Gonzalez, Udo, Morne, Rosenberg.
Critical revision of the manuscript for important intellectual content: Tesoriero, Swain, Zamboni, Wu, Holtgrave, Gonzalez, Hart-Malloy, Rajulu, Leung, Rosenberg.
Statistical analysis: Swain, Rosenberg.
Administrative, technical, or material support: Tesoriero, Pierce, Zamboni, Wu, Holtgrave, Gonzalez, Morne, Hart-Malloy, Rajulu, Leung.
Supervision: Tesoriero, Rajulu.
Conflict of Interest Disclosures: Dr Hart-Malloy reported receiving grants from the Centers for Disease Control and Prevention through the PS19-1901 Strengthening STD Prevention and Control for Health Departments during the conduct of the study. No other disclosures were reported.
Funding/Support: This study was funded by grant 1R01DA051302 from the National Institutes of Health (Dr Rosenberg).
Role of the Funder/Sponsor: The National Institutes of Health had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: Amy Kelly, MPH, New York State Department of Health AIDS Institute, contributed to literature review and editing. Heather Bradley PhD, Georgia State University, provided input on the organization of findings. They were not compensated for their contributions.
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