OBJECTIVES: To define the incidence of clinically detected coronavirus disease 2019 (COVID-19) in people with HIV (PWH) in the United States and evaluate how racial and ethnic disparities, comorbidities, and HIV-related factors contribute to risk of COVID-19. DESIGN: Observational study within the CFAR Network of Integrated Clinical Systems cohort in seven cities during 2020. METHODS: We calculated cumulative incidence rates of COVID-19 diagnosis among PWH in routine care by key characteristics including race/ethnicity, current and lowest CD4+ cell count, and geographic area. We evaluated risk factors for COVID-19 among PWH using relative risk regression models adjusted with disease risk scores. RESULTS: Among 16 056 PWH in care, of whom 44.5% were black, 12.5% were Hispanic, with a median age of 52 years (IQR 40-59), 18% had a current CD4+ cell count less than 350 cells/μl, including 7% less than 200; 95.5% were on antiretroviral therapy (ART), and 85.6% were virologically suppressed. Overall in 2020, 649 PWH were diagnosed with COVID-19 for a rate of 4.94 cases per 100 person-years. The cumulative incidence of COVID-19 was 2.4-fold and 1.7-fold higher in Hispanic and black PWH respectively, than non-Hispanic white PWH. In adjusted analyses, factors associated with COVID-19 included female sex, Hispanic or black identity, lowest historical CD4+ cell count less than 350 cells/μl (proxy for CD4+ nadir), current low CD4+ : CD8+ ratio, diabetes, and obesity. CONCLUSION: Our results suggest that the presence of structural racial inequities above and beyond medical comorbidities increased the risk of COVID-19 among PWH. PWH with immune exhaustion as evidenced by lowest historical CD4+ cell count or current low CD4+ : CD8+ ratio had greater risk of COVID-19.
OBJECTIVES: To define the incidence of clinically detected coronavirus disease 2019 (COVID-19) in people with HIV (PWH) in the United States and evaluate how racial and ethnic disparities, comorbidities, and HIV-related factors contribute to risk of COVID-19. DESIGN: Observational study within the CFAR Network of Integrated Clinical Systems cohort in seven cities during 2020. METHODS: We calculated cumulative incidence rates of COVID-19 diagnosis among PWH in routine care by key characteristics including race/ethnicity, current and lowest CD4+ cell count, and geographic area. We evaluated risk factors for COVID-19 among PWH using relative risk regression models adjusted with disease risk scores. RESULTS: Among 16 056 PWH in care, of whom 44.5% were black, 12.5% were Hispanic, with a median age of 52 years (IQR 40-59), 18% had a current CD4+ cell count less than 350 cells/μl, including 7% less than 200; 95.5% were on antiretroviral therapy (ART), and 85.6% were virologically suppressed. Overall in 2020, 649 PWH were diagnosed with COVID-19 for a rate of 4.94 cases per 100 person-years. The cumulative incidence of COVID-19 was 2.4-fold and 1.7-fold higher in Hispanic and black PWH respectively, than non-Hispanic white PWH. In adjusted analyses, factors associated with COVID-19 included female sex, Hispanic or black identity, lowest historical CD4+ cell count less than 350 cells/μl (proxy for CD4+ nadir), current low CD4+ : CD8+ ratio, diabetes, and obesity. CONCLUSION: Our results suggest that the presence of structural racial inequities above and beyond medical comorbidities increased the risk of COVID-19 among PWH. PWH with immune exhaustion as evidenced by lowest historical CD4+ cell count or current low CD4+ : CD8+ ratio had greater risk of COVID-19.
Authors: Michael S Kozak; Michael J Mugavero; Jiatao Ye; Inmaculada Aban; Sarah T Lawrence; Christa R Nevin; James L Raper; Cheryl McCullumsmith; Joseph E Schumacher; Heidi M Crane; Mari M Kitahata; Michael S Saag; James H Willig Journal: Clin Infect Dis Date: 2011-10-31 Impact factor: 9.079
Authors: Muhammad Shariq Usman; Tariq Jamal Siddiqi; Muhammad Shahzeb Khan; Urvish K Patel; Izza Shahid; Jawad Ahmed; Ankur Kalra; Erin D Michos Journal: BMJ Evid Based Med Date: 2020-08-11
Authors: John K Weiser; Yunfeng Tie; Linda Beer; Robyn Neblett Fanfair; Roy Luke Shouse Journal: J Acquir Immune Defic Syndr Date: 2021-03-01 Impact factor: 3.731
Authors: Xueying Yang; Jing Sun; Rena C Patel; Jiajia Zhang; Siyuan Guo; Qulu Zheng; Amy L Olex; Bankole Olatosi; Sharon B Weissman; Jessica Y Islam; Christopher G Chute; Melissa Haendel; Gregory D Kirk; Xiaoming Li Journal: Lancet HIV Date: 2021-10-13 Impact factor: 12.767
Authors: Gregorio A Millett; Austin T Jones; David Benkeser; Stefan Baral; Laina Mercer; Chris Beyrer; Brian Honermann; Elise Lankiewicz; Leandro Mena; Jeffrey S Crowley; Jennifer Sherwood; Patrick S Sullivan Journal: Ann Epidemiol Date: 2020-05-14 Impact factor: 3.797