1
|
Spinelli MA, Johnson MO, Lisha NE, Jain JP, Moreira CV, Glidden DV, Burkholder GA, Crane HM, Jacobson JM, Cachay ER, Mayer KH, Napravnik S, Moore RD, Gandhi M, Christopoulos KA. Prevalence and Correlates of SARS-CoV-2 Vaccine Uptake and Hesitancy Among People With HIV Across the United States. J Acquir Immune Defic Syndr 2024; 97:13-18. [PMID: 39116328 PMCID: PMC11315354 DOI: 10.1097/qai.0000000000003466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/29/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND People with HIV (PWH) have higher risk of COVID-19 mortality. SARS-CoV-2 vaccination is highly effective among PWH, although vaccine hesitancy could limit the population-level impact. SETTING From February 2021 to April 2022, PWH from 8 sites in the Centers for AIDS Research Network of Integrated Clinical Systems completed a vaccine hesitancy instrument as part of routine care. METHODS Participants were defined as vaccine hesitant if they had not received the SARS-CoV-2 vaccine and would probably/definitely not receive it. We assessed factors associated with SARS-CoV-2 vaccine hesitancy using logistic regression adjusted for demographics, unsuppressed viral load (VL > 200 copies/mL), month, and time on ART; using inverse probability weighting for survey nonresponse. RESULTS Overall, 3288 PWH with a median age of 55 were included; 18% were female and 94% were virally suppressed. At the time of survey, 27% reported they had not received the SARS-CoV-2 vaccine, and 9% (n = 279) reported vaccine hesitancy. Factors associated with vaccine hesitancy included female sex (adjusted odds ratio [AOR] = 2.3; 95% confidence interval (CI): 1.6-3.2), Black vs. White race (AOR 1.7; 95% CI: 1.2 to 2.4), younger age (AOR 1.4; 95% CI: 1.2 to 1.5), and unsuppressed VL (AOR 1.9; 95% CI: 1.3 to 3.0). CONCLUSION Overall, over one-quarter of PWH in this multisite cohort were unvaccinated for SARS-CoV-2 when interviewed February 21-April 22. Vaccine hesitancy was reported by approximately 9% of PWH and was higher among women, Black PWH, younger PWH, PWH with unsuppressed VL, and those in the South/Midwest. Renewed efforts are needed to address concerns of PWH about vaccinations against COVID-19 as the pandemic evolves, and vaccines in general, given the potential for future pandemics.
Collapse
Affiliation(s)
- Matthew A. Spinelli
- Division of HIV, ID, and Global Medicine, University of California, San Francisco
| | | | - Nadra E. Lisha
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Jennifer P. Jain
- Division of Prevention Science, University of California, San Francisco
| | - Carlos V. Moreira
- Division of HIV, ID, and Global Medicine, University of California, San Francisco
| | - David V. Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | - Heidi M. Crane
- Division of Allergy and Infectious Diseases, University of Washington
| | | | - Edward R. Cachay
- Division of Infectious Diseases, University of California, San Diego
| | | | - Sonia Napravnik
- Division of Infectious Diseases, University of North Carolina, Chapel Hill
| | | | - Monica Gandhi
- Division of HIV, ID, and Global Medicine, University of California, San Francisco
| | | |
Collapse
|
2
|
Rastogi A, Gautam S, Kumar M. Bioinformatic elucidation of conserved epitopes to design a potential vaccine candidate against existing and emerging SARS-CoV-2 variants of concern. Heliyon 2024; 10:e35129. [PMID: 39157328 PMCID: PMC11328099 DOI: 10.1016/j.heliyon.2024.e35129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/20/2024] Open
Abstract
The COVID-19 pandemic caused by SARS-CoV-2 poses a significant adverse effects on health and economy globally. Due to mutations in genome, COVID-19 vaccine efficacy decreases. We used immuno-informatics to design a Multi epitope vaccine (MEV) candidate for SARS-CoV-2 variants of concern (VOCs). Hence, we predicted binders/epitopes MHC-I, CD8+, MHC-II, CD4+, and CTLs from spike, membrane and envelope proteins of VOCs. In addition, we assessed the conservation of these binders and epitopes across different VOCs. Subsequently, we designed MEV by combining the predicted CTL and CD4+ epitopes from spike protein, peptide linkers, and an adjuvant. Further, we evaluated the binding of MEV candidate against immune receptors namely HLA class I histocompatibility antigen, HLA class II histocompatibility antigen, and TLR4, achieving binding scores of -1265.3, -1330.7, and -1337.9. Molecular dynamics and normal mode analysis revealed stable docking complexes. Moreover, immune simulation suggested MEV candidate elicits both innate and adaptive immune response. We anticipate that this conserved MEV candidate will provide protection from VOCs and emerging strains.
Collapse
Affiliation(s)
- Amber Rastogi
- Virology Unit and Bioinformatics Centre, Institute of Microbial Technology, Council of Scientific and Industrial Research (CSIR), Sector 39A, Chandigarh, 160036, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Sakshi Gautam
- Virology Unit and Bioinformatics Centre, Institute of Microbial Technology, Council of Scientific and Industrial Research (CSIR), Sector 39A, Chandigarh, 160036, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Manoj Kumar
- Virology Unit and Bioinformatics Centre, Institute of Microbial Technology, Council of Scientific and Industrial Research (CSIR), Sector 39A, Chandigarh, 160036, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| |
Collapse
|
3
|
Artigues Serra F, Pinecki Socias S, Fanjul FJ, Peñaranda M, Homar F, Sorni P, Serra J, Rey A, Ventayol L, Macia MD, Ribas MÀ, Riera M. Factors associated with SARS-CoV-2 infection among people living with HIV: Data from the Balearic cohort (EVHIA). PLoS One 2024; 19:e0308568. [PMID: 39110761 PMCID: PMC11305541 DOI: 10.1371/journal.pone.0308568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 07/25/2024] [Indexed: 08/10/2024] Open
Abstract
INTRODUCTION The impact of SARS-CoV-2 infection among people living with HIV (PLWH) has been a matter of research. We evaluated the incidence and factors associated with SARS-CoV-2 diagnosis among PLWH. We also assessed factors related to vaccination coverage in the Balearic Islands. METHODS A retrospective analytical study was performed, including patients from the Balearic cohort (EVHIA) who were visited at least twice between 1st January 2020 and 31st March 2022. Chi-square test and Mann-Whitney U test were used to compare categorical and continuous variables respectively. Multivariable Cox proportional hazards regression models were estimated to identify risk factors. RESULTS A total of 3567 patients with HIV were included. The median age was 51 years (IQR 44-59). Most of them were male (77,3%), from Europe (82,1%) or South America (13,8%). During the study period 1036 patients were diagnosed with SARS-CoV-2 infection (29%). The incidence rate was 153,24 cases per 1000 person-year. After multivariable analysis, men who have sex with men (MSM) were associated with an increased risk of SARS-CoV-2 infection (adjusted hazard ratio 1,324, 95% CI 1,138-1,540), whereas African origin, tobacco use and complete or booster vaccination coverage were negatively related. Overall, complete vaccination or booster coverage was recorded in 2845 (79,75%) patients. When analysing vaccination uptake, older patients (adjusted hazard ratio 5,122, 95% CI 3,170-8,288) and those with a modified comorbidity index of 2-3 points (adjusted hazard ratio 1,492, 95% CI 1,056-2,107) had received more vaccine doses. CONCLUSIONS In our study no HIV related factor was associated with an increased risk of SARS-CoV-2 infection, except for differences in the transmission route. Possible confounding variables such as mask wearing or social interactions could not be measured. Vaccines were of utmost importance to prevent SARS-CoV-2 infection. Efforts should be made to encourage vaccination in those groups of PLWH with less coverage.
Collapse
Affiliation(s)
- Francisca Artigues Serra
- Department of Internal Medicine, Section of Infectious Diseases, Son Espases University Hospital-IDISBA, Palma, Balearic Islands, Spain
| | - Sophia Pinecki Socias
- Department of Internal Medicine, Section of Infectious Diseases, Son Espases University Hospital-IDISBA, Palma, Balearic Islands, Spain
| | - Francisco Javier Fanjul
- Department of Internal Medicine, Section of Infectious Diseases, Son Espases University Hospital-IDISBA, Palma, Balearic Islands, Spain
| | - Maria Peñaranda
- Department of Internal Medicine, Section of Infectious Diseases, Son Espases University Hospital-IDISBA, Palma, Balearic Islands, Spain
| | - Francisco Homar
- Department of Internal Medicine, Son Llatzer University Hospital-IDISBA, Palma, Balearic Islands, Spain
| | - Patricia Sorni
- Department of Internal Medicine, Son Llatzer University Hospital-IDISBA, Palma, Balearic Islands, Spain
| | - Julia Serra
- Department of Internal Medicine, Inca Regional Hospital, Inca, Balearic Islands, Spain
| | - Adelaida Rey
- Department of Internal Medicine, Inca Regional Hospital, Inca, Balearic Islands, Spain
| | - Lola Ventayol
- Department of Internal Medicine, Manacor Regional Hospital, Manacor, Balearic Islands, Spain
| | - Maria Dolores Macia
- Department of Microbiology, Son Espases University Hospital-IDISBA CIBERINFEC, Palma, Balearic Islands, Spain
| | - Maria Àngels Ribas
- Department of Internal Medicine, Section of Infectious Diseases, Son Espases University Hospital-IDISBA, Palma, Balearic Islands, Spain
| | - Melchor Riera
- Department of Internal Medicine, Section of Infectious Diseases, Son Espases University Hospital-IDISBA CIBERINFEC, Palma, Balearic Islands, Spain
| |
Collapse
|
4
|
Gagliardini R, Giacomelli A, Bozzi G, D'Arminio Monforte A, Tavelli A, Mazzotta V, Bruzzesi E, Cervo A, Saracino A, Mussini C, Girardi E, Cozzi-Lepri A, Antinori A. Impact of COVID-19 pandemic on retention in care of native and migrant people with HIV in the ICONA cohort. Travel Med Infect Dis 2024; 58:102691. [PMID: 38336335 DOI: 10.1016/j.tmaid.2024.102691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/19/2023] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND COVID-19 pandemic challenged the UNAIDS 90-90-90 targets. How the COVID-19 pandemic affected HIV retention in care and whether it has disproportionally affected migrant people with HIV (PWH) remained to be investigated. METHODS PWH in ICONA Cohort in follow-up in each of the study periods were included: 01/09/2019-29/02/2020 (pandemic period) and 01/03/2018-31/08/2018 (historical period, as a control). Risk of temporary loss to follow-up (LTFU, defined as no data recorded for a person for one year) was analyzed by logistic regression, with migrant status as the main exposure variable. Difference in difference (DID) analysis was applied to evaluate the effect of COVID-19 pandemic in the different risk of LTFU between natives and migrants. RESULTS 8864 (17.1% migrants) and 8071 (16.8% migrants) PWH constituted the pandemic and the historical period population, respectively. Proportion of PWH defined as LTFU in the pandemic period was 10.5% in native and 19.6% in migrant PWH. After controlling for age, sex and geographical location of enrolling site, risk of temporary LTFU was higher for migrants than native PWH [adjusted odds ratio 1.85 (95%CI 1.54-2.22)] in pandemic period. In PWH contributing to both periods, LTFU was 9.0% (95% CI 8.3-9.8) in natives vs 17.0% (95% CI 14.7-19.4) in migrants during the pandemic. Instead, LTFU was 1.2% (95%CI 0.9, 1.5) in natives vs 2.2% (95% CI 1.3-3.1) in migrants during the historical period, with a resulting DID of 7.0% (95% CI 4.4-9.6). CONCLUSIONS A greater proportion of LTFU in migrant PWH was observed in both periods, which remained unaltered over time. Interventions to reduce LTFU of migrants are necessary.
Collapse
Affiliation(s)
- Roberta Gagliardini
- Clinical and Research Infectious Diseases Department, National Institute of Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Giacomelli
- III Infectious Disease Unit, ASST-Fatebenefratelli Sacco, Milan, Italy
| | - Giorgio Bozzi
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | - Valentina Mazzotta
- Clinical and Research Infectious Diseases Department, National Institute of Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Elena Bruzzesi
- UO Malattie Infettive, IRCCS Ospedale San Raffaele, Italy
| | - Adriana Cervo
- Division of Infectious Diseases, University of Modena, Modena, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, University Hospital, University of Bari, Bari, Italy
| | - Cristina Mussini
- Division of Infectious Diseases, University of Modena, Modena, Italy
| | - Enrico Girardi
- Scientific Direction, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Andrea Antinori
- Clinical and Research Infectious Diseases Department, National Institute of Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| |
Collapse
|
5
|
Shi F, Zhang J, Yang X, Gao H, Chen S, Weissman S, Olatosi B, Li X. COVID-19 Testing Among People with HIV: A Population Level Analysis Based on Statewide Data in South Carolina. AIDS Behav 2023:10.1007/s10461-023-04244-4. [PMID: 38109020 DOI: 10.1007/s10461-023-04244-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2023] [Indexed: 12/19/2023]
Abstract
People with HIV (PWH) are at an elevated risk of developing severe COVID-19 outcomes because of compromised immunity and more comorbidities. However, existing literature suggests a lower rate of COVID-testing among PWH. This study aimed to explore the temporal trend of county-level COVID-19 testing rate and multi-level predictors of COVID-19 ever-testing among PWH in South Carolina (SC). Leveraging linked statewide HIV and COVID-19 datasets, we defined the study population as all adult (18 + years) PWH who were alive on March 2020 and living in SC. PWH with a COVID-19 testing record between March 2020 and October 2021 were defined as COVID-19 ever-testers. Logistic regression and generalized mixed models were used to investigate the association of PWH's demographic profile, HIV clinical characteristics (e.g., CD4 count, viral load), comorbidities, and social factors with COVID-19 testing among PWH. Among 15,660 adult PWH, 8,005 (51.12%) had ever tested for COVID-19 during the study period (March 2020-October 2021). PWH with older age, being male, and Hispanics were less likely to take COVID-19 testing, while men who have sex with men or injection drug users were more likely to take COVID-19 testing. PWH with higher recent viral load (10,000-100,000 copies/ml vs. <200 copies/ml: adjusted odds ratio [AOR]: 0.64, 95%CI: 0.55-0.75) and lower CD4 counts (> 350 cells/mm3 vs. <200 cells/mm3: AOR: 1.25, 95%CI: 1.09-1.45) had lower odds for COVID-19 testing. Additionally, PWH with lower comorbidity burden and those living in rural areas were less likely to be tested for COVID-19. Differences in COVID-19 test-seeking behaviors were observed among PWH in the current study, which could help provide empirical evidence to inform the prioritization of further disease monitoring and targeted intervention. More efforts on building effective surveillance and screening systems are needed to allow early case detection and curbing disease transmission among older, male, Hispanic, and immune-suppressed PWH, especially in rural areas.
Collapse
Affiliation(s)
- Fanghui Shi
- South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Columbia, SC, US.
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, US.
- Big Data Health Science Center, University of South Carolina, Columbia, SC, US.
| | - Jiajia Zhang
- South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Columbia, SC, US
- Big Data Health Science Center, University of South Carolina, Columbia, SC, US
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, US
| | - Xueying Yang
- South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Columbia, SC, US
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, US
- Big Data Health Science Center, University of South Carolina, Columbia, SC, US
| | - Haoyuan Gao
- South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Columbia, SC, US
- Big Data Health Science Center, University of South Carolina, Columbia, SC, US
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, US
| | - Shujie Chen
- South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Columbia, SC, US
- Big Data Health Science Center, University of South Carolina, Columbia, SC, US
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, US
| | - Sharon Weissman
- Big Data Health Science Center, University of South Carolina, Columbia, SC, US
- School of Medicine, University of South Carolina, Columbia, SC, US
| | - Bankole Olatosi
- South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Columbia, SC, US
- Big Data Health Science Center, University of South Carolina, Columbia, SC, US
- Department of Health Services, Policy, and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina, Columbia, SC, US
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, US
- Big Data Health Science Center, University of South Carolina, Columbia, SC, US
| |
Collapse
|
6
|
Bergersen KV, Pham K, Li J, Ulrich MT, Merrill P, He Y, Alaama S, Qiu X, Harahap-Carrillo IS, Ichii K, Frost S, Kaul M, Godzik A, Heinrich EC, Nair MG. Health disparities in COVID-19: immune and vascular changes are linked to disease severity and persist in a high-risk population in Riverside County, California. BMC Public Health 2023; 23:1584. [PMID: 37598150 PMCID: PMC10439554 DOI: 10.1186/s12889-023-16462-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/05/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Health disparities in underserved communities, such as inadequate healthcare access, impact COVID-19 disease outcomes. These disparities are evident in Hispanic populations nationwide, with disproportionately high infection and mortality rates. Furthermore, infected individuals can develop long COVID with sustained impacts on quality of life. The goal of this study was to identify immune and endothelial factors that are associated with COVID-19 outcomes in Riverside County, a high-risk and predominantly Hispanic community, and investigate the long-term impacts of COVID-19 infection. METHODS 112 participants in Riverside County, California, were recruited according to the following criteria: healthy control (n = 23), outpatients with moderate infection (outpatient, n = 33), ICU patients with severe infection (hospitalized, n = 33), and individuals recovered from moderate infection (n = 23). Differences in outcomes between Hispanic and non-Hispanic individuals and presence/absence of co-morbidities were evaluated. Circulating immune and vascular biomarkers were measured by ELISA, multiplex analyte assays, and flow cytometry. Follow-up assessments for long COVID, lung health, and immune and vascular changes were conducted after recovery (n = 23) including paired analyses of the same participants. RESULTS Compared to uninfected controls, the severe infection group had a higher proportion of Hispanic individuals (n = 23, p = 0.012) than moderate infection (n = 8, p = 0.550). Disease severity was associated with changes in innate monocytes and neutrophils, lymphopenia, disrupted cytokine production (increased IL-8 and IP-10/CXCL10 but reduced IFNλ2/3 and IFNγ), and increased endothelial injury (myoglobin, VCAM-1). In the severe infection group, a machine learning model identified LCN2/NGAL, IL-6, and monocyte activation as parameters associated with fatality while anti-coagulant therapy was associated with survival. Recovery from moderate COVID infection resulted in long-term immune changes including increased monocytes/lymphocytes and decreased neutrophils and endothelial markers. This group had a lower proportion of co-morbidities (n = 8, p = 1.0) but still reported symptoms associated with long COVID despite recovered pulmonary function. CONCLUSION This study indicates increased severity of COVID-19 infection in Hispanic individuals of Riverside County, California. Infection resulted in immunological and vascular changes and long COVID symptoms that were sustained for up to 11 months, however, lung volume and airflow resistance was recovered. Given the immune and behavioral impacts of long COVID, the potential for increased susceptibility to infections and decreased quality of life in high-risk populations warrants further investigation.
Collapse
Affiliation(s)
- Kristina V Bergersen
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, CA, U.S
| | - Kathy Pham
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, CA, U.S
| | - Jiang Li
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, CA, U.S
| | - Michael T Ulrich
- Riverside University Health System Medical Center, Riverside, CA, U.S
| | - Patrick Merrill
- Kaiser Permanente Riverside Medical Center, Riverside, CA, U.S
| | - Yuxin He
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, CA, U.S
| | - Sumaya Alaama
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, CA, U.S
| | - Xinru Qiu
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, CA, U.S
| | - Indira S Harahap-Carrillo
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, CA, U.S
| | - Keita Ichii
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, CA, U.S
| | - Shyleen Frost
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, CA, U.S
| | - Marcus Kaul
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, CA, U.S
| | - Adam Godzik
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, CA, U.S
| | - Erica C Heinrich
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, CA, U.S..
| | - Meera G Nair
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, CA, U.S..
| |
Collapse
|
7
|
Hanna JJ, Geresu LB, Diaz MI, Ho M, Casazza JA, Pickering MA, Lanier HD, Radunsky AP, Cooper LN, Saleh SN, Bedimo RJ, Most ZM, Perl TM, Lehmann CU, Turer RW, Chow JY, Medford RJ. Risk Factors for SARS-CoV-2 Infection and Severe Outcomes Among People With Human Immunodeficiency Virus: Cohort Study. Open Forum Infect Dis 2023; 10:ofad400. [PMID: 37577110 PMCID: PMC10416813 DOI: 10.1093/ofid/ofad400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/22/2023] [Indexed: 08/15/2023] Open
Abstract
Background Studies on COVID-19 in people with HIV (PWH) have had limitations. Further investigations on risk factors and outcomes of SARS-CoV-2 infection among PWH are needed. Methods This retrospective cohort study leveraged the national OPTUM COVID-19 data set to investigate factors associated with SARS-CoV-2 positivity among PWH and risk factors for severe outcomes, including hospitalization, intensive care unit stays, and death. A subset analysis was conducted to examine HIV-specific variables. Multiple variable logistic regression was used to adjust for covariates. Results Of 43 173 PWH included in this study, 6472 had a positive SARS-CoV-2 result based on a polymerase chain reaction test or antigen test. For PWH with SARS-CoV-2 positivity, higher odds were found for those who were younger (18-49 years), Hispanic White, African American, from the US South, uninsured, and a noncurrent smoker and had a higher body mass index and higher Charlson Comorbidity Index. For PWH with severe outcomes, higher odds were identified for those who were SARS-CoV-2 positive, older, from the US South, receiving Medicaid/Medicare or uninsured, a current smoker, and underweight and had a higher Charlson Comorbidity Index. In a subset analysis including PWH with HIV care variables (n = 5098), those with unsuppressed HIV viral load, a low CD4 count, and no antiretroviral therapy had higher odds of severe outcomes. Conclusions This large US study found significant ethnic, racial, and geographic differences in SARS-CoV-2 infection among PWH. Chronic comorbidities, older age, lower body mass index, and smoking were associated with severe outcomes among PWH during the COVID-19 pandemic. SARS-CoV-2 infection was associated with severe outcomes, but once we adjusted for HIV care variables, SARS-CoV-2 was no longer significant; however, low CD4 count, high viral load, and lack of antiretroviral therapy had higher odds of severe outcomes.
Collapse
Affiliation(s)
- John J Hanna
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Liyu B Geresu
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Healthcare Informatics, Children’s Health Hospitals and Health Care, Dallas, Texas, USA
| | - Marlon I Diaz
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Milan Ho
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Julia A Casazza
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Madison A Pickering
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Heather D Lanier
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alexander P Radunsky
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lauren N Cooper
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sameh N Saleh
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Roger J Bedimo
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Zachary M Most
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Trish M Perl
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Christoph U Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
- Lyda Hill Department of Bioinformatics, UT Southwestern Medical Center, Dallas, Texas, USA
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Robert W Turer
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jeremy Y Chow
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Richard J Medford
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
8
|
Kassanjee R, Davies M, Ngwenya O, Osei‐Yeboah R, Jacobs T, Morden E, Timmerman V, Britz S, Mendelson M, Taljaard J, Riou J, Boulle A, Tiffin N, Zinyakatira N. COVID-19 among adults living with HIV: correlates of mortality among public sector healthcare users in Western Cape, South Africa. J Int AIDS Soc 2023; 26:e26104. [PMID: 37339333 PMCID: PMC10281639 DOI: 10.1002/jia2.26104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 05/02/2023] [Indexed: 06/22/2023] Open
Abstract
INTRODUCTION While a large proportion of people with HIV (PWH) have experienced SARS-CoV-2 infections, there is uncertainty about the role of HIV disease severity on COVID-19 outcomes, especially in lower-income settings. We studied the association of mortality with characteristics of HIV severity and management, and vaccination, among adult PWH. METHODS We analysed observational cohort data on all PWH aged ≥15 years experiencing a diagnosed SARS-CoV-2 infection (until March 2022), who accessed public sector healthcare in the Western Cape province of South Africa. Logistic regression was used to study the association of mortality with evidence of antiretroviral therapy (ART) collection, time since first HIV evidence, CD4 cell count, viral load (among those with evidence of ART collection) and COVID-19 vaccination, adjusting for demographic characteristics, comorbidities, admission pressure, location and time period. RESULTS Mortality occurred in 5.7% (95% CI: 5.3,6.0) of 17,831 first-diagnosed infections. Higher mortality was associated with lower recent CD4, no evidence of ART collection, high or unknown recent viral load and recent first HIV evidence, differentially by age. Vaccination was protective. The burden of comorbidities was high, and tuberculosis (especially more recent episodes of tuberculosis), chronic kidney disease, diabetes and hypertension were associated with higher mortality, more strongly in younger adults. CONCLUSIONS Mortality was strongly associated with suboptimal HIV control, and the prevalence of these risk factors increased in later COVID-19 waves. It remains a public health priority to ensure PWH are on suppressive ART and vaccinated, and manage any disruptions in care that occurred during the pandemic. The diagnosis and management of comorbidities, including for tuberculosis, should be optimized.
Collapse
Affiliation(s)
- Reshma Kassanjee
- School of Public HealthUniversity of Cape TownCape TownSouth Africa
| | - Mary‐Ann Davies
- School of Public HealthUniversity of Cape TownCape TownSouth Africa
- Department of HealthWestern Cape GovernmentCape TownSouth Africa
| | - Olina Ngwenya
- Wellcome Centre for Infectious Disease Research in AfricaInstitute of Infectious Diseases and Molecular MedicineUniversity of Cape TownCape TownSouth Africa
| | - Richard Osei‐Yeboah
- Division of Computational BiologyIntegrative Biomedical Sciences DepartmentFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Theuns Jacobs
- Department of HealthWestern Cape GovernmentCape TownSouth Africa
| | - Erna Morden
- School of Public HealthUniversity of Cape TownCape TownSouth Africa
- Department of HealthWestern Cape GovernmentCape TownSouth Africa
| | - Venessa Timmerman
- School of Public HealthUniversity of Cape TownCape TownSouth Africa
- Department of HealthWestern Cape GovernmentCape TownSouth Africa
| | - Stefan Britz
- Department of Statistical SciencesUniversity of Cape TownCape TownSouth Africa
| | - Marc Mendelson
- Division of Infectious Diseases and HIV MedicineDepartment of MedicineGroote Schuur HospitalUniversity of Cape TownCape TownSouth Africa
| | - Jantjie Taljaard
- Division of Infectious DiseasesDepartment of MedicineTygerberg HospitalStellenbosch UniversityCape TownSouth Africa
| | - Julien Riou
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
| | - Andrew Boulle
- School of Public HealthUniversity of Cape TownCape TownSouth Africa
- Department of HealthWestern Cape GovernmentCape TownSouth Africa
| | - Nicki Tiffin
- South African National Bioinformatics InstituteUniversity of the Western CapeCape TownSouth Africa
| | - Nesbert Zinyakatira
- School of Public HealthUniversity of Cape TownCape TownSouth Africa
- Department of HealthWestern Cape GovernmentCape TownSouth Africa
| |
Collapse
|
9
|
Moran CA, Oliver NT, Szabo B, Collins LF, Nguyen MLT, Shah NS, Moanna A, Colasanti JA, Cantos VD, Armstrong WS, Sheth AN, Ofotokun I, Kelley CF, Marconi VC, Lahiri CD. The association between comorbidities and coronavirus disease 2019 hospitalization among people with HIV differs by age. AIDS 2023; 37:71-81. [PMID: 36111530 PMCID: PMC9742289 DOI: 10.1097/qad.0000000000003386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To determine whether factors associated with coronavirus disease 2019 (COVID-19) hospitalization among people with HIV (PWH) differ by age stratum. DESIGN Retrospective cohort study. METHODS All adult PWH with a positive SARS-CoV-2 PCR in a public safety-net health system between 1 March 2020 and 28 February 2021 and a Veterans Affairs Medical Center between 1 1 March 2020 and 15 November 2020 in Atlanta, Georgia were included. We performed multivariable logistic regression to determine demographic and clinical factors associated with COVID-19 hospitalization overall and stratified by age less than 50 and at least 50 years. RESULTS Three hundred and sixty-five PWH (mean age 49 years, 74% cisgender male, 82% black) were included. Ninety-six percent were on antiretroviral therapy (ART), 87% had CD4 + T-cell count at least 200 cells/μl, and 89% had HIV-1 RNA less than 200 copies/ml. Overall, age [adjusted odds ratio (aOR) 95% confidence interval (CI) 1.07 (1.04-1.10)], later date of SARS-CoV-2 infection [aOR 0.997 (0.995-1.00)], heart disease [aOR 2.27 (1.06-4.85)], and history of hepatitis C virus (HCV) [aOR 2.59 (1.13-5.89)] were associated with COVID-19 hospitalization. Age-adjusted comorbidity burden was associated with 30% increased risk of hospitalization [aOR 1.30 (1.11-1.54)]. Among 168 PWH less than 50 years old, older age [aOR 1.09 (1.01-1.18)] and no ART use [aOR 40.26 (4.12-393.62)] were associated with hospitalization; age-adjusted comorbidity burden was not ( P = 0.25). Among 197 PWH at least 50, older age [aOR 1.10 (1.04-1.16)], heart disease [aOR 2.45 (1.04-5.77)], history of HCV [aOR 3.52 (1.29-9.60)], and age-adjusted comorbidity burden [aOR 1.36 (1.12-1.66)] were associated with hospitalization. CONCLUSION Comorbidity burden is more strongly associated with COVID-19 hospitalization among older, rather than younger, PWH. These findings may have important implications for risk-stratifying COVID-19 therapies and booster recommendations in PWH.
Collapse
Affiliation(s)
- Caitlin A Moran
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
| | - Nora T Oliver
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Atlanta Veterans Affairs Medical Center, Decatur
| | | | - Lauren F Collins
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
| | - Minh Ly T Nguyen
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
| | - N Sarita Shah
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Atlanta Veterans Affairs Medical Center, Decatur
- Department of Epidemiology
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Abeer Moanna
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Atlanta Veterans Affairs Medical Center, Decatur
| | - Jonathan A Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Valeria D Cantos
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
| | - Wendy S Armstrong
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
| | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
| | - Ighovwerha Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
| | - Colleen F Kelley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
| | - Vincent C Marconi
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
- Atlanta Veterans Affairs Medical Center, Decatur
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Cecile D Lahiri
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
- Grady Health System, Atlanta
| |
Collapse
|