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COVID-19 Outcomes Among Persons Living With or Without Diagnosed HIV Infection in New York State

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  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?

Findings  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.

Meaning  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.


Importance  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.

Objective  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.

Exposures  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.

Results  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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Article Information

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 (

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.

Johns Hopkins University. COVID-19 United States cases by county. 2020. Accessed December 15, 2020.
Meyerowitz  EA , Kim  AY , Ard  KL ,  et al.  Disproportionate burden of coronavirus disease 2019 among racial minorities and those in congregate settings among a large cohort of people with HIV.   AIDS. 2020;34(12):1781-1787. doi:10.1097/QAD.0000000000002607 PubMedGoogle ScholarCrossref
Kalichman  SC , Eaton  LA , Berman  M ,  et al.  Intersecting pandemics: impact of SARS-CoV-2 (COVID-19) protective behaviors on people living with HIV, Atlanta, Georgia.   J Acquir Immune Defic Syndr. 2020;85(1):66-72. doi:10.1097/QAI.0000000000002414 PubMedGoogle ScholarCrossref
Sigel  K , Swartz  T , Golden  E ,  et al.  Coronavirus 2019 and people with human immunodeficiency virus: outcomes for hospitalized patients in New York City.   Clin Infect Dis. 2020;71(11):2933-2938. doi:10.1093/cid/ciaa880 PubMedGoogle Scholar
Centers for Disease Control and Prevention. People with certain medical conditions. Updated December 28, 2020. Accessed January 3, 2021.
Okoh  AK , Bishburg  E , Grinberg  S , Nagarakanti  S .  COVID-19 pneumonia in patients with HIV: a case series.   J Acquir Immune Defic Syndr. 2020;85(1):e4-e5. doi:10.1097/QAI.0000000000002411 PubMedGoogle ScholarCrossref
Shalev  N , Scherer  M , LaSota  ED ,  et al.  Clinical characteristics and outcomes in people living with human immunodeficiency virus hospitalized for coronavirus disease 2019.   Clin Infect Dis. 2020;71(16):2294-2297. doi:10.1093/cid/ciaa635PubMedGoogle ScholarCrossref
Vizcarra  P , Pérez-Elías  MJ , Quereda  C ,  et al; COVID-19 ID Team.  Description of COVID-19 in HIV-infected individuals: a single-centre, prospective cohort.   Lancet HIV. 2020;7(8):e554-e564. doi:10.1016/S2352-3018(20)30164-8 PubMedGoogle ScholarCrossref
Patel  VV , Felsen  UR , Fisher  M ,  et al. Clinical outcomes by HIV serostatus, CD4 count, and viral suppression among people hospitalized with COVID-19 in the Bronx, New York. Presented at 23rd International AIDS Conference; July 10, 2020.
Guo  W , Ming  F, , Dong  Y ,  et al.  A survey for COVID-19 among HIV/AIDS patients in two districts of Wuhan, China.  Published online March 13, 2020. Accessed November 4, 2020. doi:10.2139/ssrn.3550029
Karmen-Tuohy  S , Carlucci  PM , Zervou  FN ,  et al.  Outcomes among HIV-positive patients hospitalized with COVID-19.   J Acquir Immune Defic Syndr. 2020;85(1):6-10. doi:10.1097/QAI.0000000000002423 PubMedGoogle ScholarCrossref
Gervasoni  C , Meraviglia  P , Riva  A ,  et al.  Clinical features and outcomes of patients with human immunodeficiency virus with COVID-19.   Clin Infect Dis. 2020;71(16):2276-2278. doi:10.1093/cid/ciaa579PubMedGoogle ScholarCrossref
Davies  MA .  HIV and risk of COVID-19 death: a population cohort study from the Western Cape Province, South Africa.  Preprint. Posted July 3, 2020. medRxiv 20145185. doi:10.1101/2020.07.02.20145185
Childs  K , Post  FA , Norcross  C ,  et al.  Hospitalized patients with COVID-19 and human immunodeficiency virus: a case series.   Clin Infect Dis. 2020;71(8):2021-2022. doi:10.1093/cid/ciaa657PubMedGoogle ScholarCrossref
Suwanwongse  K , Shabarek  N .  Clinical features and outcome of HIV/SARS-CoV-2 coinfected patients in The Bronx, New York city.   J Med Virol. 2020;92(11):2387-2389. doi:10.1002/jmv.26077 PubMedGoogle ScholarCrossref
Braunstein  SL , Lazar  R , Wahnich  A , Daskalakis  DC , Blackstock  OJ .  COVID-19 infection among people with HIV in New York City: A population-level analysis of linked surveillance data.   Clin Infect Dis. 2020;ciaa1793. Published online November 30, 2020. doi:10.1093/cid/ciaa1793PubMedGoogle Scholar
Centers for Disease Control and Prevention. HIV surveillance report, 2018 updated edition, volume 31. Published May 2020. Accessed November 4, 2020.
New York State Department of Health, AIDS Institute, Bureau of HIV/AIDS Epidemiology. New York state HIV/AIDS annual surveillance report for persons diagnosed through December 2018. December 2019. Accessed July 17, 2020.
Holtgrave  DR , Barranco  MA , Tesoriero  JM , Blog  DS , Rosenberg  ES .  Assessing racial and ethnic disparities using a COVID-19 outcomes continuum for New York State.   Ann Epidemiol. 2020;48:9-14. doi:10.1016/j.annepidem.2020.06.010 PubMedGoogle ScholarCrossref
New York State Department of Health. Part 63: HIV/AIDS testing, reporting and confidentiality of HIV-related information. Accessed December 28, 2020.
New York State. Statutory authority: public health law. Sect. §2786 and Article 21.
SAS Institute Inc. SAS. Assessed October 15, 2020.
Rosenberg  ES , Dufort  EM , Udo  T ,  et al.  Association of treatment with hydroxychloroquine or azithromycin with in-hospital mortality in patients with COVID-19 in New York state.   JAMA. 2020;323(24):2493-2502. doi:10.1001/jama.2020.8630 PubMedGoogle ScholarCrossref
Caristix. HL7 v2.5 - 0112 - discharge disposition. 2020. Accessed October 15, 2020.
Centers for Disease Control and Prevention. Technical guidance for HIV surveillance programs: adult HIV confidential case report form. February 2018. Accessed November 4, 2020.
Sabharwal  CJ , Braunstein  SL , Robbins  RS , Shepard  CW .  Optimizing the use of surveillance data for monitoring the care status of persons recently diagnosed with HIV in NYC.   J Acquir Immune Defic Syndr. 2014;65(5):571-578. doi:10.1097/QAI.0000000000000077 PubMedGoogle ScholarCrossref
Swain  CA , Smith  LC , Nash  D ,  et al.  Postpartum human immunodeficiency virus care among women diagnosed during pregnancy.   Obstet Gynecol. 2016;128(1):44-51. doi:10.1097/AOG.0000000000001454 PubMedGoogle ScholarCrossref
National Center for Health Statistics. US census populations with bridged race categories. Accessed November 4, 2020.
Rothman KJ, Lash TL, Greenland S.  Modern Epidemiology. 3rd ed. Lippincott, Williams & Wilkins; 2008.
van Buuren  S .  Multiple imputation of discrete and continuous data by fully conditional specification.   Stat Methods Med Res. 2007;16(3):219-242. doi:10.1177/0962280206074463 PubMedGoogle ScholarCrossref
SAS Institute Inc. SAS/STAT 14.1 user’s guide: the MI procedure. Accessed October 15, 2020.
Ssentongo  P , Heilbrunnes  ES , Ssentongo  AE ,  et al.  Prevalence of HIV in patients hospitalized for COVID-19 and associated outcomes: a systematic review and meta-analysis.  Preprint. Posted July 6, 2020. medRxiv 20143628. doi:10.1101/2020.07.03.20143628
Del Amo  J , Polo  R , Moreno  S ,  et al; The Spanish HIV/COVID-19 Collaboration.  Incidence and severity of COVID-19 in HIV-positive persons receiving antiretroviral therapy: a cohort study.   Ann Intern Med. 2020;173(7):536-541. doi:10.7326/M20-3689 PubMedGoogle ScholarCrossref
Huang  VS , Sutermaster  S , Caplan  Y ,  et al.  Social distancing across vulnerability, race, politics, and employment: how different Americans changed behaviors before and after major COVID-19 policy announcements.  Preprint. Posted June 8, 2020. medRxiv 20119131. doi:10.1101/2020.06.04.20119131
Millett  GA , Honermann  B , Jones  A ,  et al.  White counties stand apart: the primacy of residential segregation in COVID-19 and HIV diagnoses.   AIDS Patient Care STDS. 2020;34(10):417-424. doi:10.1089/apc.2020.0155 PubMedGoogle ScholarCrossref
Millett  GA , Jones  AT , Benkeser  D ,  et al.  Assessing differential impacts of COVID-19 on black communities.   Ann Epidemiol. 2020;47:37-44. doi:10.1016/j.annepidem.2020.05.003 PubMedGoogle ScholarCrossref
Rodriguez-Diaz  CE , Guilamo-Ramos  V , Mena  L ,  et al.  Risk for COVID-19 infection and death among Latinos in the United States: examining heterogeneity in transmission dynamics.   Ann Epidemiol. 2020;52:46-53. doi:10.1016/j.annepidem.2020.07.007 PubMedGoogle ScholarCrossref
Wang  QQ , Kaelber  DC , Xu  R , Volkow  ND .  Correction: COVID-19 risk and outcomes in patients with substance use disorders: analyses from electronic health records in the United States.   Mol Psychiatry. Published online September 30, 2020. doi:10.1038/s41380-020-00895-0 PubMedGoogle Scholar
Rossen  LM , Branum  AM , Ahmad  FB , Sutton  P , Anderson  RN .  Excess deaths associated with COVID-19, by age and race and ethnicity—United States, January 26-October 3, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(42):1522-1527. doi:10.15585/mmwr.mm6942e2 PubMedGoogle ScholarCrossref
Dandachi  D , Geiger  G , Montgomery  MW ,  et al; HIV-COVID-19 Consortium.  Characteristics, comorbidities, and outcomes in a multicenter registry of patients with HIV and coronavirus disease-19.   Clin Infect Dis. 2020;ciaa1339. doi:10.1093/cid/ciaa1339 PubMedGoogle Scholar
Blanco  JL , Ambrosioni  J , Garcia  F ,  et al; COVID-19 in HIV Investigators.  COVID-19 in patients with HIV: clinical case series.   Lancet HIV. 2020;7(5):e314-e316. doi:10.1016/S2352-3018(20)30111-9 PubMedGoogle ScholarCrossref
De Francesco  D , Wit  FW , Bürkle  A ,  et al; the Co-morBidity in Relation to AIDS (COBRA) Collaboration.  Do people living with HIV experience greater age advancement than their HIV-negative counterparts?   AIDS. 2019;33(2):259-268. doi:10.1097/QAD.0000000000002063 PubMedGoogle ScholarCrossref
Lagathu  C , Cossarizza  A , Béréziat  V , Nasi  M , Capeau  J , Pinti  M .  Basic science and pathogenesis of ageing with HIV: potential mechanisms and biomarkers.   AIDS. 2017;31(suppl 2):S105-S119. doi:10.1097/QAD.0000000000001441 PubMedGoogle ScholarCrossref
Azar  KMJ , Shen  Z , Romanelli  RJ ,  et al.  Disparities in outcomes among COVID-19 patients in a large health care system in California.   Health Aff (Millwood). 2020;39(7):1253-1262. doi:10.1377/hlthaff.2020.00598 PubMedGoogle ScholarCrossref
Rentsch  CT , Kidwai-Khan  F , Tate  JP ,  et al.  Covid-19 by race and ethnicity: a national cohort study of 6 million United States veterans.  Preprint. Posted May 18, 2020. medRxiv 20099135. doi:10.1101/2020.05.12.20099135
Price-Haywood  EG , Burton  J , Fort  D , Seoane  L .  Hospitalization and mortality among Black patients and White patients with Covid-19.   N Engl J Med. 2020;382(26):2534-2543. doi:10.1056/NEJMsa2011686 PubMedGoogle ScholarCrossref
Rosenberg  ES , Tesoriero  JM , Rosenthal  EM ,  et al.  Cumulative incidence and diagnosis of SARS-CoV-2 infection in New York.   Ann Epidemiol. 2020;48:23-29. doi:10.1016/j.annepidem.2020.06.004 PubMedGoogle ScholarCrossref
The National Academies of Sciences, Engineering, and Medicine. A framework for equitable allocation of vaccine for the novel coronavirus. Accessed December 16, 2020.
New York State Department of Health. New York State’s COVID-19 vaccination program. Accessed December 16, 2020.
Shiau  S , Krause  KD , Valera  P , Swaminathan  S , Halkitis  PN .  The burden of COVID-19 in people living with HIV: a syndemic perspective.   AIDS Behav. 2020;24(8):2244-2249. doi:10.1007/s10461-020-02871-9 PubMedGoogle ScholarCrossref
Zang  X , Krebs  E , Chen  S ,  et al.  The potential epidemiological impact of COVID-19 on the HIV/AIDS epidemic and the cost-effectiveness of linked, opt-out HIV testing: a modeling study in six US cities.   Clin Infect Dis. 2020;ciaa1547. doi:10.1093/cid/ciaa1547 PubMedGoogle Scholar
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