1. Sociodemographic, clinical, and immunological factors associated with SARS-CoV-2 diagnosis and severe COVID-19 outcomes in people living with HIV: a retrospective cohort study
- Author
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Emili Letang, Lorena de la Mora, Sergio Moreno, Montse Laguno, Cristina Cortés, Paula Suanzes, Helem Haydee Vilchez, Esteban Martínez, Jordi Casabona, María Martínez-Rebollar, Francisco Homar, Ingrid Vilaró, Hernando Knobel, María Leyes, Marina Martínez, Alexy Inciarte, Antoni Jou, Jorge Palacio, Pilar Barrufet, Rocio Sola, Elena Leon, Isabel Mur, Felipe García, Angels Jaén, Àngels Masabeu, Elisa de Lazzari, Roser Font, Jose Carlos Rubia, Patrícia Sorní, Bibiana Morell, Ana Silva, José Luis Santiago Blanco, Adrià Curran, Thaïs Comella, Vicenç Falcó, Iván Chivite, Lluís Force, Anna Esteve, Mireia Cairó, Joaquim Peraire, Francesc Vidal, Francisco Fanjul, Berta Torres, Laia Arbones, Maria Saumoy, Josep Vilà, Jordi Aceiton, Guillem Fernandez, Ainoa Ugarte, Joaquín Burgos, David Dalmau, Maria Angels Ribas, Carmen Cifuentes, Josep Mallolas, Lucía Rodríguez, Rosa Maria Vivanco-Hidalgo, Pere Domingo, Eva González, Andreu Bruguera, Elisabet Deig, Consuleo Viladés, Josep M. Llibre, Lorna Leal, Juan Ambrosioni, Montserrat Vargas, Anna Martí, Arkaitz Imaz, Yesika Díaz, Marta Navarro, Aroa Villoslada, Antoni Campins, Freya Gargoulas, Manel Cervantes, Esteve Muntada, Melchor Riera, Sofia Scévola, Javier Murillas, Daniel Podzamczer, Toni Vanrell, Xavier Martinez-Lacas, Jordi Navarro, Antoni Payeras, Sonia Calzado, Maria Gracia Mateo, Elena Chamarro, Leire Berrocal, Ana González-Cordón, Maria Luisa Martin, Juliana Reyes-Urueña, Marta Molero, M. José Amengual, Maribel Tamayo, José M. Miró, Daniel Kwakye Nomah, Amat-Joaquim Orti, Jose Vicente Fernández-Montero, Maria del Mar Gutierrez, Gemma Navarro, Lizza Macorigh, María Peñaranda, and Nadia Abdulghani
- Subjects
Adult ,Male ,medicine.medical_specialty ,COVID-19 Vaccines ,Epidemiology ,Immunology ,HIV Infections ,Severity of Illness Index ,Men who have sex with men ,Cohort Studies ,COVID-19 Testing ,Virology ,Intensive care ,Internal medicine ,Medicine ,Humans ,Immunologic Factors ,Survival analysis ,Aged ,Retrospective Studies ,Asphyxia ,Aged, 80 and over ,business.industry ,Proportional hazards model ,SARS-CoV-2 ,Hazard ratio ,COVID-19 ,Retrospective cohort study ,Articles ,Middle Aged ,Infectious Diseases ,Socioeconomic Factors ,Spain ,Immunoglobulin G ,Cohort ,Female ,medicine.symptom ,business - Abstract
Summary Background Factors affecting outcomes of SARS-CoV-2 infection in people living with HIV are unclear. We assessed the factors associated with SARS-CoV-2 diagnosis and severe outcomes among people living with HIV. Methods We did a retrospective cohort study using data from the PISCIS cohort of people with HIV in Catalonia (Spain) between March 1 and Dec 15, 2020. We linked PISCIS data with integrated health-care, clinical, and surveillance registries through the Public Data Analysis for Health Research and Innovation Program of Catalonia (PADRIS) to obtain data on SARS-CoV-2 diagnosis, chronic comorbidities, as well as clinical and mortality outcomes. Participants were aged at least 16 years in care at 16 hospitals in Catalonia. Factors associated with SARS-CoV-2 diagnoses and severe outcomes were assessed using univariable and multivariable Cox regression models. We estimated the effect of immunosuppression on severe outcomes (hospital admission for >24 h with dyspnoea, tachypnoea, hypoxaemia, asphyxia, or hyperventilation; or death) using Kaplan-Meier survival analysis. Findings We linked 20 847 (72·8%) of 28 666 participants in the PISCIS cohort with PADRIS data; 13 142 people had HIV. 749 (5·7%) people with HIV were diagnosed with SARS-CoV-2: their median age was 43·5 years (IQR 37·0–52·7), 131 (17·5%) were female, and 618 (82·5%) were male. 103 people with HIV (13·8%) were hospitalised, seven (0·9%) admitted to intensive care, and 13 (1·7%) died. SARS-CoV-2 diagnosis was more common among migrants (adjusted hazard ratio 1·55, 95% CI 1·31–1·83), men who have sex with men (1·42, 1·09–1·86), and those with four or more chronic comorbidities (1·46, 1·09–1·97). Age at least 75 years (5·2, 1·8–15·3), non-Spanish origin (2·1, 1·3–3·4), and neuropsychiatric (1·69, 1·07–2·69), autoimmune disease (1·92, 1·14–3·23), respiratory disease (1·84, 1·09–3·09), and metabolic disease (2·59, 1·59–4·23) chronic comorbidities were associated with increased risk of severe outcomes. A Kaplan-Meier estimator showed differences in the risk of severe outcomes according to CD4 cell count in patients with detectable HIV RNA (p=0·039) but no differences were observed in patients with undetectable HIV RNA (p=0·15). Interpretation People living with HIV with detectable HIV viraemia, chronic comorbidities, and some subpopulations could be at increased risk of severe outcomes from COVID-19. These groups should be prioritised in clinical management and SARS-CoV-2 vaccination programmes. Funding Fundacio "la Caixa". Translations For the Catalan, Spanish and Russian translations of the Summary see Supplementary Materials section.
- Published
- 2021