Clinical outcomes of patients with and without HIV hospitalized with COVID-19 in England during the early stages of the pandemic: a matched retrospective multi-centre analysis (RECEDE-C19 study)

Ming Jie Lee; Luke Blagdon Snell; Sam T. Douthwaite; Sarah Fidler; Naomi Fitzgerald; Lynsey Goodwin; Lisa Hamzah; Ranjababu Kulasegaram; Sarah Lawrence; Julianne Lwanga; Rebecca Marchant; Chloe Orkin; Adrian Palfreeman; Padmini Parthasarathi; Manish Pareek; Kyle Ring; Hamed Sharaf; Eleanor Shekarchi-Khanghahi; Rebecca Simons; Jhia Jiat Teh; John Thornhill; Clare van Halsema; Marie Williamson; Martin Wiselka; Achyuta Nori; Julie Fox; Colette Smith

doi:10.1111/hiv.13174

Clinical outcomes of patients with and without HIV hospitalized with COVID-19 in England during the early stages of the pandemic: a matched retrospective multi-centre analysis (RECEDE-C19 study)

Ming Jie Lee, Luke Blagdon Snell, Sam T. Douthwaite, Sarah Fidler, Naomi Fitzgerald, Lynsey Goodwin, Lisa Hamzah, Ranjababu Kulasegaram, Sarah Lawrence, Julianne Lwanga, Rebecca Marchant, Chloe Orkin, Adrian Palfreeman, Padmini Parthasarathi, Manish Pareek, Kyle Ring, Hamed Sharaf, Eleanor Shekarchi-Khanghahi, Rebecca Simons, Jhia Jiat TehJohn Thornhill, Clare van Halsema, Marie Williamson, Martin Wiselka, Achyuta Nori, Julie Fox, Colette Smith

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

Abstract

Background: The contribution of HIV to COVID-19 outcomes in hospitalized inpatients remains unclear. We conducted a multi-centre, retrospective matched cohort study of SARS-CoV-2 PCR-positive hospital inpatients analysed by HIV status. Methods: HIV-negative patients were matched to people living with HIV (PLWH) admitted from 1 February 2020 to 31 May 2020 up to a 3:1 ratio by the following: hospital site, SARS-CoV-2 test date ± 7 days, age ± 5 years, gender, and index of multiple deprivation decile ± 1. The primary objective was clinical improvement (two-point improvement or better on a seven-point ordinal scale) or hospital discharge by day 28, whichever was earlier. Results: A total of 68 PLWH and 181 HIV-negative comparators were included. In unadjusted analyses, PLWH had a reduced hazard of achieving clinical improvement or discharge [adjusted hazard ratio (aHR) = 0.57, 95% confidence interval (CI): 0.39–0.85, p = 0.005], but this association was ameliorated (aHR = 0.70, 95% CI: 0.43–1.17, p = 0.18) after additional adjustment for ethnicity, frailty, baseline hypoxaemia, duration of symptoms prior to baseline, body mass index (BMI) categories and comorbidities. Baseline frailty (aHR = 0.79, 95% CI: 0.65–0.95, p = 0.011), malignancy (aHR = 0.37, 95% CI 0.17, 0.82, p = 0.014) remained associated with poorer outcomes. The PLWH were more likely to be of black, Asian and minority ethnic background (75.0% vs 48.6%, p = 0.0002), higher median clinical frailty score [3 × interquartile range (IQR): 2–5 vs, 2 × IQR: 1–4, p = 0.0069), and to have a non-significantly higher proportion of active malignancy (14.4% vs 9.9%, p = 0.29). Conclusions: Adjusting for confounding comorbidities and demographics in a matched cohort ameliorated differences in outcomes of PLWH hospitalized with COVID-19, highlighting the importance of an appropriate comparison group when assessing outcomes of PLWH hospitalized with COVID-19.

Original language	English
Pages (from-to)	121-133
Number of pages	13
Journal	HIV MEDICINE
Volume	23
Issue number	2
DOIs	https://doi.org/10.1111/hiv.13174
Publication status	Published - Feb 2022

Keywords

comorbidities
COVID-19
HIV

UN SDGs

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

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10.1111/hiv.13174

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Lee, M. J., Snell, L. B., Douthwaite, S. T., Fidler, S., Fitzgerald, N., Goodwin, L., Hamzah, L., Kulasegaram, R., Lawrence, S., Lwanga, J., Marchant, R., Orkin, C., Palfreeman, A., Parthasarathi, P., Pareek, M., Ring, K., Sharaf, H., Shekarchi-Khanghahi, E., Simons, R., ... Smith, C. (2022). Clinical outcomes of patients with and without HIV hospitalized with COVID-19 in England during the early stages of the pandemic: a matched retrospective multi-centre analysis (RECEDE-C19 study). HIV MEDICINE, 23(2), 121-133. https://doi.org/10.1111/hiv.13174

@article{f546bfb7faf14c49a828a36089fd1b36,

title = "Clinical outcomes of patients with and without HIV hospitalized with COVID-19 in England during the early stages of the pandemic: a matched retrospective multi-centre analysis (RECEDE-C19 study)",

abstract = "Background: The contribution of HIV to COVID-19 outcomes in hospitalized inpatients remains unclear. We conducted a multi-centre, retrospective matched cohort study of SARS-CoV-2 PCR-positive hospital inpatients analysed by HIV status. Methods: HIV-negative patients were matched to people living with HIV (PLWH) admitted from 1 February 2020 to 31 May 2020 up to a 3:1 ratio by the following: hospital site, SARS-CoV-2 test date ± 7 days, age ± 5 years, gender, and index of multiple deprivation decile ± 1. The primary objective was clinical improvement (two-point improvement or better on a seven-point ordinal scale) or hospital discharge by day 28, whichever was earlier. Results: A total of 68 PLWH and 181 HIV-negative comparators were included. In unadjusted analyses, PLWH had a reduced hazard of achieving clinical improvement or discharge [adjusted hazard ratio (aHR) = 0.57, 95% confidence interval (CI): 0.39–0.85, p = 0.005], but this association was ameliorated (aHR = 0.70, 95% CI: 0.43–1.17, p = 0.18) after additional adjustment for ethnicity, frailty, baseline hypoxaemia, duration of symptoms prior to baseline, body mass index (BMI) categories and comorbidities. Baseline frailty (aHR = 0.79, 95% CI: 0.65–0.95, p = 0.011), malignancy (aHR = 0.37, 95% CI 0.17, 0.82, p = 0.014) remained associated with poorer outcomes. The PLWH were more likely to be of black, Asian and minority ethnic background (75.0% vs 48.6%, p = 0.0002), higher median clinical frailty score [3 × interquartile range (IQR): 2–5 vs, 2 × IQR: 1–4, p = 0.0069), and to have a non-significantly higher proportion of active malignancy (14.4% vs 9.9%, p = 0.29). Conclusions: Adjusting for confounding comorbidities and demographics in a matched cohort ameliorated differences in outcomes of PLWH hospitalized with COVID-19, highlighting the importance of an appropriate comparison group when assessing outcomes of PLWH hospitalized with COVID-19.",

keywords = "comorbidities, COVID-19, HIV",

author = "Lee, {Ming Jie} and Snell, {Luke Blagdon} and Douthwaite, {Sam T.} and Sarah Fidler and Naomi Fitzgerald and Lynsey Goodwin and Lisa Hamzah and Ranjababu Kulasegaram and Sarah Lawrence and Julianne Lwanga and Rebecca Marchant and Chloe Orkin and Adrian Palfreeman and Padmini Parthasarathi and Manish Pareek and Kyle Ring and Hamed Sharaf and Eleanor Shekarchi-Khanghahi and Rebecca Simons and Teh, {Jhia Jiat} and John Thornhill and {van Halsema}, Clare and Marie Williamson and Martin Wiselka and Achyuta Nori and Julie Fox and Colette Smith",

note = "Funding Information: MJL has received grants and honoraria from Gilead Sciences and Viiv Healthcare not related to this work. SF has received research grants to her institution from National Institutes of Health (NIH), Medical Research Council (MRC) and Bill and Melinda Gates Foundation (BMGF). JT has received support for virtual conference registration from ViiV Healthcare and research grants from the Medical Research Council and the British HIV Association not related to this work. CvH has received educational grants, conference support and advisory board fees from ViiV Healthcare, Gilead Sciences and Merck, Sharkp & Dohme not related to this work. MP reports grants and personal fees from Gilead Sciences and personal fees from Qiagen, outside the submitted work. MP is supported by a National Institute for Health Research (NIHR) Development and Skills Enhancement Award (NIHR301192) and in receipt of funding from UK Research & Innovation (UKRI) / MRC (MR/V027549/1). He acknowledges the support from UKRI, the NIHR Leicester Biomedical Research Centre (BRC) and NIHR Applied Research Collaboration (ARC) East Midlands. No other competing interests, financial relationships with any organizations that might have an interest in the submitted work, or other relationships or activities that could appear to have influenced the submitted work have been reported by other authors. Funding Information: This study used data collected in the routine care of NHS patients, by the NHS staff involved in their care and we acknowledge both patients and staff in their contributions to this study. We acknowledge the support of Alice Sharp, Elizabeth Bruna, Marie‐Rose Dwek, Jo Bagshaw, Venkateshwaran Sivaraj and Shirin Hussein. Publisher Copyright: {\textcopyright} 2021 British HIV Association.",

year = "2022",

month = feb,

doi = "10.1111/hiv.13174",

language = "English",

volume = "23",

pages = "121--133",

journal = "HIV MEDICINE",

issn = "1464-2662",

publisher = "Wiley-Blackwell",

number = "2",

}

Lee, MJ, Snell, LB, Douthwaite, ST, Fidler, S, Fitzgerald, N, Goodwin, L, Hamzah, L, Kulasegaram, R, Lawrence, S, Lwanga, J, Marchant, R, Orkin, C, Palfreeman, A, Parthasarathi, P, Pareek, M, Ring, K, Sharaf, H, Shekarchi-Khanghahi, E, Simons, R, Teh, JJ, Thornhill, J, van Halsema, C, Williamson, M, Wiselka, M, Nori, A, Fox, J & Smith, C 2022, 'Clinical outcomes of patients with and without HIV hospitalized with COVID-19 in England during the early stages of the pandemic: a matched retrospective multi-centre analysis (RECEDE-C19 study)', HIV MEDICINE, vol. 23, no. 2, pp. 121-133. https://doi.org/10.1111/hiv.13174

Clinical outcomes of patients with and without HIV hospitalized with COVID-19 in England during the early stages of the pandemic: a matched retrospective multi-centre analysis (RECEDE-C19 study). / Lee, Ming Jie; Snell, Luke Blagdon; Douthwaite, Sam T. et al.

In: HIV MEDICINE, Vol. 23, No. 2, 02.2022, p. 121-133.

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

TY - JOUR

T1 - Clinical outcomes of patients with and without HIV hospitalized with COVID-19 in England during the early stages of the pandemic: a matched retrospective multi-centre analysis (RECEDE-C19 study)

AU - Lee, Ming Jie

AU - Snell, Luke Blagdon

AU - Douthwaite, Sam T.

AU - Fidler, Sarah

AU - Fitzgerald, Naomi

AU - Goodwin, Lynsey

AU - Hamzah, Lisa

AU - Kulasegaram, Ranjababu

AU - Lawrence, Sarah

AU - Lwanga, Julianne

AU - Marchant, Rebecca

AU - Orkin, Chloe

AU - Palfreeman, Adrian

AU - Parthasarathi, Padmini

AU - Pareek, Manish

AU - Ring, Kyle

AU - Sharaf, Hamed

AU - Shekarchi-Khanghahi, Eleanor

AU - Simons, Rebecca

AU - Teh, Jhia Jiat

AU - Thornhill, John

AU - van Halsema, Clare

AU - Williamson, Marie

AU - Wiselka, Martin

AU - Nori, Achyuta

AU - Fox, Julie

AU - Smith, Colette

N1 - Funding Information: MJL has received grants and honoraria from Gilead Sciences and Viiv Healthcare not related to this work. SF has received research grants to her institution from National Institutes of Health (NIH), Medical Research Council (MRC) and Bill and Melinda Gates Foundation (BMGF). JT has received support for virtual conference registration from ViiV Healthcare and research grants from the Medical Research Council and the British HIV Association not related to this work. CvH has received educational grants, conference support and advisory board fees from ViiV Healthcare, Gilead Sciences and Merck, Sharkp & Dohme not related to this work. MP reports grants and personal fees from Gilead Sciences and personal fees from Qiagen, outside the submitted work. MP is supported by a National Institute for Health Research (NIHR) Development and Skills Enhancement Award (NIHR301192) and in receipt of funding from UK Research & Innovation (UKRI) / MRC (MR/V027549/1). He acknowledges the support from UKRI, the NIHR Leicester Biomedical Research Centre (BRC) and NIHR Applied Research Collaboration (ARC) East Midlands. No other competing interests, financial relationships with any organizations that might have an interest in the submitted work, or other relationships or activities that could appear to have influenced the submitted work have been reported by other authors. Funding Information: This study used data collected in the routine care of NHS patients, by the NHS staff involved in their care and we acknowledge both patients and staff in their contributions to this study. We acknowledge the support of Alice Sharp, Elizabeth Bruna, Marie‐Rose Dwek, Jo Bagshaw, Venkateshwaran Sivaraj and Shirin Hussein. Publisher Copyright: © 2021 British HIV Association.

PY - 2022/2

Y1 - 2022/2

N2 - Background: The contribution of HIV to COVID-19 outcomes in hospitalized inpatients remains unclear. We conducted a multi-centre, retrospective matched cohort study of SARS-CoV-2 PCR-positive hospital inpatients analysed by HIV status. Methods: HIV-negative patients were matched to people living with HIV (PLWH) admitted from 1 February 2020 to 31 May 2020 up to a 3:1 ratio by the following: hospital site, SARS-CoV-2 test date ± 7 days, age ± 5 years, gender, and index of multiple deprivation decile ± 1. The primary objective was clinical improvement (two-point improvement or better on a seven-point ordinal scale) or hospital discharge by day 28, whichever was earlier. Results: A total of 68 PLWH and 181 HIV-negative comparators were included. In unadjusted analyses, PLWH had a reduced hazard of achieving clinical improvement or discharge [adjusted hazard ratio (aHR) = 0.57, 95% confidence interval (CI): 0.39–0.85, p = 0.005], but this association was ameliorated (aHR = 0.70, 95% CI: 0.43–1.17, p = 0.18) after additional adjustment for ethnicity, frailty, baseline hypoxaemia, duration of symptoms prior to baseline, body mass index (BMI) categories and comorbidities. Baseline frailty (aHR = 0.79, 95% CI: 0.65–0.95, p = 0.011), malignancy (aHR = 0.37, 95% CI 0.17, 0.82, p = 0.014) remained associated with poorer outcomes. The PLWH were more likely to be of black, Asian and minority ethnic background (75.0% vs 48.6%, p = 0.0002), higher median clinical frailty score [3 × interquartile range (IQR): 2–5 vs, 2 × IQR: 1–4, p = 0.0069), and to have a non-significantly higher proportion of active malignancy (14.4% vs 9.9%, p = 0.29). Conclusions: Adjusting for confounding comorbidities and demographics in a matched cohort ameliorated differences in outcomes of PLWH hospitalized with COVID-19, highlighting the importance of an appropriate comparison group when assessing outcomes of PLWH hospitalized with COVID-19.

AB - Background: The contribution of HIV to COVID-19 outcomes in hospitalized inpatients remains unclear. We conducted a multi-centre, retrospective matched cohort study of SARS-CoV-2 PCR-positive hospital inpatients analysed by HIV status. Methods: HIV-negative patients were matched to people living with HIV (PLWH) admitted from 1 February 2020 to 31 May 2020 up to a 3:1 ratio by the following: hospital site, SARS-CoV-2 test date ± 7 days, age ± 5 years, gender, and index of multiple deprivation decile ± 1. The primary objective was clinical improvement (two-point improvement or better on a seven-point ordinal scale) or hospital discharge by day 28, whichever was earlier. Results: A total of 68 PLWH and 181 HIV-negative comparators were included. In unadjusted analyses, PLWH had a reduced hazard of achieving clinical improvement or discharge [adjusted hazard ratio (aHR) = 0.57, 95% confidence interval (CI): 0.39–0.85, p = 0.005], but this association was ameliorated (aHR = 0.70, 95% CI: 0.43–1.17, p = 0.18) after additional adjustment for ethnicity, frailty, baseline hypoxaemia, duration of symptoms prior to baseline, body mass index (BMI) categories and comorbidities. Baseline frailty (aHR = 0.79, 95% CI: 0.65–0.95, p = 0.011), malignancy (aHR = 0.37, 95% CI 0.17, 0.82, p = 0.014) remained associated with poorer outcomes. The PLWH were more likely to be of black, Asian and minority ethnic background (75.0% vs 48.6%, p = 0.0002), higher median clinical frailty score [3 × interquartile range (IQR): 2–5 vs, 2 × IQR: 1–4, p = 0.0069), and to have a non-significantly higher proportion of active malignancy (14.4% vs 9.9%, p = 0.29). Conclusions: Adjusting for confounding comorbidities and demographics in a matched cohort ameliorated differences in outcomes of PLWH hospitalized with COVID-19, highlighting the importance of an appropriate comparison group when assessing outcomes of PLWH hospitalized with COVID-19.

KW - comorbidities

KW - COVID-19

KW - HIV

UR - http://www.scopus.com/inward/record.url?scp=85115295978&partnerID=8YFLogxK

U2 - 10.1111/hiv.13174

DO - 10.1111/hiv.13174

M3 - Article

SN - 1464-2662

VL - 23

SP - 121

EP - 133

JO - HIV MEDICINE

JF - HIV MEDICINE

IS - 2

ER -

Clinical outcomes of patients with and without HIV hospitalized with COVID-19 in England during the early stages of the pandemic: a matched retrospective multi-centre analysis (RECEDE-C19 study)

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Keywords

UN SDGs

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