Risk factors for the coronavirus disease 2019 (COVID-19), which is a disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and its associated mortality include older age, male gender, and co-morbidities such as hypertension, diabetes, chronic cardiovascular and respiratory diseases, as well as immunosuppressed conditions. However, the risk factors for hospitalization among clinically stable people with the human immunodeficiency virus (HIV) (PWH) are unclear.
Study: Increasing Numbers of Non-communicable Disease Co-morbidities: Major Risk Factors For Hospitalization among a Cohort with HIV and COVID-19 Coinfection. Image Credit: Halfpoint / Shutterstock.com
Many studies have shown contradicting observations on the clinical outcomes among PWH. Whereas some studies report no excess risk of morbidity and mortality with PWH and COVID-19, others have indicated that up to 65% of the COVID-19 PWH were hospitalized in this last year.
“While there is growing evidence that HIV-associated immunosuppression is not thought to be associated with COVID-19-related hospitalization or death, indirect measures of HIV and aging, as manifested in co-morbidities, still correlate with COVID-19 hospitalization.”
About the study
To gain a better understanding of the risks of hospitalization among the PWH infected with SARS-CoV-2, researchers from the Yale School of Medicine collaborated with the University of Michigan to conduct a cohort study at the Yale-New Haven Hospital (YNHH) in New Haven, Connecticut.
Between January 21, 2020, and January 20, 2021, a total of 103 PWH who were 18 years old or over and had a laboratory-confirmed SARS-CoV-2 infection were identified and included in the study. All these patients received their primary care at two HIV ambulatory clinics and were divided into hospitalized and ambulatory groups. Taken together, PWH patients with COVID-19 comprised about 7% of the 1,469 PWH who were receiving care at the two clinics.
Among the PWHs with COVID-19, 33% were hospitalized and 67% were ambulatory. Notably, the hospitalized PWH represented less than 1% of all COVID-19-related admissions during the study period.
Further, those who were hospitalized were at least 65 years old and were more likely to have chronic lung disease or cardiovascular disease. A history of acquired immunodeficiency syndrome (AIDS) and the last CD4 count was not associated with hospitalization.
Despite those who were on antiretroviral therapy (ART) or exhibited HIV viral load (HIVVL) suppression, no significant difference was observed between the inpatients and outpatients. While the direct antiviral benefit of ART could explain the less severe disease in these individuals, it did not appear to have an effect on the clinical course or outcome of these patients.
In addition to the small size of this retrospective study, other limitations include that the data collected here at a single urban institution may not represent the global population of the PWH. Additionally, PWHs from these clinics may have been tested for SARS-COV-2 or hospitalized elsewhere, which could affect the number of COVID-19 cases reported in PWHs in this community.
Although COVID-19 disproportionately affects disadvantaged populations, patients in this study had access to advanced treatments and achieved favorable outcomes overall. Importantly, this study was conducted before COVID-19 vaccines became available to the general public; therefore, the associated risks in PWH may be altered under present circumstances.
The current study confirmed that the hospitalization of PWH with COVID-19 is related to host factors such as older age and the presence of multiple co-morbidities, rather than due to traditional metrics of HIV disease or immunosuppression. While reaffirming other risk factors for COVID-19 related morbidity and mortality, such as old age and other co-morbidities, this study also showed that HIV-attributable factors were not associated with hospitalization for COVID-19.
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