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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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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 & 7 more John Thornhill, Clare van Halsema, Marie Williamson, Martin Wiselka, Achyuta Nori, Julie Fox, Colette Smith

Original languageEnglish
Pages (from-to)121-133
Number of pages13
JournalHIV MEDICINE
Volume23
Issue number2
DOIs
PublishedFeb 2022

Bibliographical 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: © 2021 British HIV Association.

King's Authors

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.

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