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 journalArticlepeer-review

11 Citations (Scopus)

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 languageEnglish
Pages (from-to)121-133
Number of pages13
JournalHIV MEDICINE
Volume23
Issue number2
DOIs
Publication statusPublished - Feb 2022

Keywords

  • comorbidities
  • COVID-19
  • HIV

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