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Moreno-Echevarria FM, Caputo MT, Camp DM, Reddy S, Achenbach CJ. Incidence and risk factors of omicron variant SARS-CoV-2 breakthrough infection among vaccinated and boosted individuals. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.03.24305293. [PMID: 38633797 PMCID: PMC11023664 DOI: 10.1101/2024.04.03.24305293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Background SARS-CoV-2 vaccines have been shown to be safe and effective against infection and severe COVID-19 disease worldwide. Certain co-morbid conditions cause immune dysfunction and may reduce immune response to vaccination. In contrast, those with co-morbidities may practice infection prevention strategies. Thus, the real-world clinical impact of co-morbidities on SARS-CoV-2 infection in the recent post-vaccination period is not well established. We performed this study to understand the epidemiology of Omicron breakthrough infection and evaluate associations with number of comorbidities in a vaccinated and boosted population. Methods and Findings We performed a retrospective clinical cohort study utilizing the Northwestern Medicine Enterprise Data Warehouse. Our study population was identified as fully vaccinated adults with at least one booster. The primary risk factor of interest was the number of co-morbidities. Our primary outcome was incidence and time to first positive SARS-CoV-2 molecular test in the Omicron predominant era. We performed multivariable analyses stratified by calendar time using Cox modeling to determine hazard of SARS-CoV-2. In total, 133,191 patients were analyzed. Having 3+ comorbidities was associated with increased hazard for breakthrough (HR=1.2 CI 1.2-1.6). During the second half of the study, having 2 comorbidities (HR= 1.1 95% CI 1.02-1.2) and having 3+ comorbidities (HR 1.7, 95% CI 1.5-1.9) were associated with increased hazard for Omicron breakthrough. Older age was associated with decreased hazard in the first 6 months of follow-up. Interaction terms for calendar time indicated significant changes in hazard for many factors between the first and second halves of the follow-up period. Conclusions Omicron breakthrough is common with significantly higher risk for our most vulnerable patients with multiple co-morbidities. Age related behavioral factors play an important role in breakthrough infection with the highest incidence among young adults. Our findings reflect real-world differences in immunity and exposure risk behaviors for populations vulnerable to COVID-19.
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Affiliation(s)
| | - Mathew T. Caputo
- Department of Medicine, Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University
| | - Daniel M. Camp
- Robert J. Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University
| | - Susheel Reddy
- Department of Medicine, Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University
| | - Chad J. Achenbach
- Robert J. Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University
- Department of Medicine, Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University
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Sun J, Zheng Q, Anzalone AJ, Abraham AG, Olex AL, Zhang Y, Mathew J, Safdar N, Haendel MA, Segev D, Islam JY, Singh JA, Mannon RB, Chute CG, Patel RC, Kirk GD. Effectiveness of mRNA Booster Vaccine Against Coronavirus Disease 2019 Infection and Severe Outcomes Among Persons With and Without Immune Dysfunction: A Retrospective Cohort Study of National Electronic Medical Record Data in the United States. Open Forum Infect Dis 2024; 11:ofae019. [PMID: 38379569 PMCID: PMC10878052 DOI: 10.1093/ofid/ofae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/09/2024] [Indexed: 02/22/2024] Open
Abstract
Background Real-world evidence of coronavirus disease 2019 (COVID-19) messenger RNA (mRNA) booster effectiveness among patients with immune dysfunction are limited. Methods We included data from patients in the United States National COVID Cohort Collaborative (N3C) who completed ≥2 doses of mRNA vaccination between 10 December 2020 and 27 May 2022. Immune dysfunction conditions included human immunodeficiency virus infection, solid organ or bone marrow transplant, autoimmune diseases, and cancer. We defined incident COVID-19 BTI as positive results from laboratory tests or diagnostic codes 14 days after at least 2 doses of mRNA vaccination; and severe COVID-19 BTI as hospitalization, invasive cardiopulmonary support, and/or death. We used propensity scores to match boosted versus nonboosted patients and evaluated hazards of incident and severe COVID-19 BTI using Cox regression after matching. Results Among patients without immune dysfunction, the relative effectiveness of booster (3 doses) after 6 months from the primary (2 doses) vaccination against BTI ranged from 69% to 81% during the Delta-predominant period and from 33% to 39% during the Omicron-predominant period. Relative effectiveness against BTI was lower among patients with immune dysfunction but remained statistically significant in both periods. Boosted patients had lower risk of COVID-19-related hospitalization (hazard ratios [HR] ranged from 0.5 [95% confidence interval {CI}, .48-.53] to 0.63 [95% CI, .56-.70]), invasive cardiopulmonary support, or death (HRs ranged from 0.46 [95% CI, .41-.52] to 0.63 [95% CI, .50-.79]) during both periods. Conclusions Booster vaccines remain effective against severe COVID-19 BTI throughout the Delta- and Omicron-predominant periods, regardless of patients' immune status.
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Affiliation(s)
- Jing Sun
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Qulu Zheng
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alfred J Anzalone
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Alison G Abraham
- Department of Epidemiology, University of Colorado, Anschutz Medical Campus, Denver, Colorado, USA
| | - Amy L Olex
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Yifan Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jomol Mathew
- Department of Population Health Sciences, University of Wisconsin–Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Nasia Safdar
- Department of Medicine, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Division of Infectious Diseases, William S. Middleton Veterans Affairs Hospital, Madison, Wisconsin, USA
| | - Melissa A Haendel
- Center for Health Artificial Intelligence, University of Colorado, Denver, Colorado, USA
| | - Dorry Segev
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jessica Y Islam
- Center for Immunization and Infection in Cancer, Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, Florida, USA
| | - Jasvinder A Singh
- Department of Medicine and Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Roslyn B Mannon
- Division of Nephrology, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Christopher G Chute
- Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rena C Patel
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gregory D Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Nomah DK, Díaz Y, Bruguera A, Moreno-Fornés S, Aceiton J, Reyes-Urueña J, Llibre JM, Falcó V, Imaz A, Fanjul FJ, Peraire J, Deig E, Domingo P, Inciarte A, Casabona J, Miró JM. Disparities in Coronavirus Disease 2019 Clinical Outcomes and Vaccination Coverage Among Migrants With Human Immunodeficiency Virus in the PISCIS Cohort: A Population-Based Propensity Score-Matched Analysis. Open Forum Infect Dis 2024; 11:ofad693. [PMID: 38221982 PMCID: PMC10785217 DOI: 10.1093/ofid/ofad693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) disproportionately affects migrants and ethnic minorities, including those with human immunodeficiency virus (HIV). Comprehensive studies are needed to understand the impact and risk factors. Methods Using data from the PISCIS cohort of people with HIV (PWH) in Catalonia, Spain, we investigated COVID-19 outcomes and vaccination coverage. Among 10 640 PWH we compared migrants and non-migrants assessing rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing, diagnosis, and associated clinical outcomes through propensity score matching and multivariable Cox regression. Results The cohort (mean age, 43 years; 83.5% male) included 57.4% (3053) Latin American migrants. Migrants with HIV (MWH) had fewer SARS-CoV-2 tests (67.8% vs 72.1%, P < .0001) but similar COVID-19 diagnoses (29.2% vs 29.4%, P = .847) compared to Spanish natives. Migrants had lower complete vaccination (78.9% vs 85.1%, P < .0001) and booster doses (63.0% vs 65.5%, P = .027). COVID-19 hospitalizations (8.1% vs 5.1%, P < .0001) and intensive care unit (ICU) admissions (2.9% vs 1.2%, P < .0001) were higher among migrants, with similar hospitalization duration (5.5 vs 4.0 days, P = .098) and mortality (3 [0.2%] vs 6 [0.4%], P = .510). Age ≥40 years, CD4 counts <200 cells/μL, ≥2 comorbidities, and incomplete/nonreception of the SARS-CoV-2 vaccine increased the risk of severe COVID-19 among migrants. Conclusions MWH had lower rates of SARS-CoV-2 testing and vaccination coverage, although the rates of COVID-19 diagnosis were similar between migrants and non-migrants. Rates of COVID-19-associated hospitalizations and ICU admissions were higher among migrants in comparison with non-migrants, with similar hospitalization duration and mortality. These findings can inform policies to address disparities in future pandemic responses for MWH.
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Affiliation(s)
- Daniel K Nomah
- Department de Salut, Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya, Generalitat de Catalunya, Badalona, Spain
- Institut d’Investigació Germans Trias i Pujol, Barcelona, Spain
| | - Yesika Díaz
- Department de Salut, Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya, Generalitat de Catalunya, Badalona, Spain
- Institut d’Investigació Germans Trias i Pujol, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública, Barcelona, Spain
| | - Andreu Bruguera
- Department de Salut, Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya, Generalitat de Catalunya, Badalona, Spain
- Institut d’Investigació Germans Trias i Pujol, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública, Barcelona, Spain
- Departament de Pediatria, d’Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Sergio Moreno-Fornés
- Department de Salut, Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya, Generalitat de Catalunya, Badalona, Spain
- Institut d’Investigació Germans Trias i Pujol, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública, Barcelona, Spain
| | - Jordi Aceiton
- Department de Salut, Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya, Generalitat de Catalunya, Badalona, Spain
- Institut d’Investigació Germans Trias i Pujol, Barcelona, Spain
| | - Juliana Reyes-Urueña
- Department de Salut, Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya, Generalitat de Catalunya, Badalona, Spain
| | - Josep M Llibre
- Fight Against Infections Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Vicenç Falcó
- Infectious Disease Division, Hospital Universitari Vall D’Hebron, Barcelona, Spain
| | - Arkaitz Imaz
- HIV and STI Unit, Department of Infectious Diseases, Hospital Universitari de Bellvitge–IDIBELL, L’Hospitalet de Llobregat, Spain
| | | | - Joaquim Peraire
- Hospital Joan XXIII, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Tarragona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Elisabet Deig
- Infectious Diseases Unit, Hospital General de Granollers, Granollers, Spain
| | - Pere Domingo
- Department of Infectious Diseases, HIV Infection Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alexy Inciarte
- Hospital Clínic-Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Jordi Casabona
- Department de Salut, Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya, Generalitat de Catalunya, Badalona, Spain
- Institut d’Investigació Germans Trias i Pujol, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública, Barcelona, Spain
- Departament de Pediatria, d’Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - José M Miró
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
- Hospital Clínic-Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
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Nomah DK, Reyes-Urueña J, Alonso L, Díaz Y, Moreno-Fornés S, Aceiton J, Bruguera A, Martín-Iguacel R, Imaz A, Gutierrez MDM, Román RW, Suanzes P, Ambrosioni J, Casabona J, Miro JM, Llibre JM. Comparative Analysis of Primary and Monovalent Booster SARS-CoV-2 Vaccination Coverage in Adults with and without HIV in Catalonia, Spain. Vaccines (Basel) 2023; 12:44. [PMID: 38250857 PMCID: PMC10819920 DOI: 10.3390/vaccines12010044] [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] [Received: 12/07/2023] [Revised: 12/18/2023] [Accepted: 12/23/2023] [Indexed: 01/23/2024] Open
Abstract
People with HIV (PWH) may be more susceptible to SARS-CoV-2 infection and worse clinical outcomes. We investigated the disparity in SARS-CoV-2 vaccination coverage between PWH and those without HIV (PWoH) in Catalonia, Spain, assessing primary and monovalent booster vaccination coverage from December 2021 to July 2022. The vaccines administered were BNT162, ChAdOx1-S, mRNA-127, and Ad26.COV2.S. Using a 1:10 ratio of PWH to PWoH based on sex, age, and socioeconomic deprivation, the analysis included 201,630 individuals (183,300 PWoH and 18,330 PWH). Despite a higher prevalence of comorbidities, PWH exhibited lower rates of complete primary vaccination (78.2% vs. 81.8%, p < 0.001) but surpassed PWoH in booster coverage (68.5% vs. 63.1%, p < 0.001). Notably, complete vaccination rates were lower among PWH with CD4 <200 cells/μL, detectable HIV viremia, and migrants compared to PWoH (p < 0.001, all). However, PWH with CD4 < 200 cells/μL received more boosters (p < 0.001). In multivariable logistic regression analysis of the overall population, a prior SARS-CoV-2 diagnosis, HIV status, migrants, and mild-to-severe socioeconomic deprivation were associated with lower primary vaccination coverage, reflecting barriers to healthcare and vaccine access. However, booster vaccination was higher among PWH. Targeted interventions are needed to improve vaccine coverage and address hesitancy in vulnerable populations.
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Affiliation(s)
- Daniel Kwakye Nomah
- Center for Epidemiological Studies of Sexually Transmitted Diseases and HIV/AIDS in Catalonia (CEEISCAT), Department of Health, Government of Catalunya, 08916 Badalona, Spain; (J.R.-U.); (L.A.); (Y.D.); (S.M.-F.); (J.A.); (A.B.); (R.M.-I.); (J.C.)
- Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| | - Juliana Reyes-Urueña
- Center for Epidemiological Studies of Sexually Transmitted Diseases and HIV/AIDS in Catalonia (CEEISCAT), Department of Health, Government of Catalunya, 08916 Badalona, Spain; (J.R.-U.); (L.A.); (Y.D.); (S.M.-F.); (J.A.); (A.B.); (R.M.-I.); (J.C.)
| | - Lucía Alonso
- Center for Epidemiological Studies of Sexually Transmitted Diseases and HIV/AIDS in Catalonia (CEEISCAT), Department of Health, Government of Catalunya, 08916 Badalona, Spain; (J.R.-U.); (L.A.); (Y.D.); (S.M.-F.); (J.A.); (A.B.); (R.M.-I.); (J.C.)
| | - Yesika Díaz
- Center for Epidemiological Studies of Sexually Transmitted Diseases and HIV/AIDS in Catalonia (CEEISCAT), Department of Health, Government of Catalunya, 08916 Badalona, Spain; (J.R.-U.); (L.A.); (Y.D.); (S.M.-F.); (J.A.); (A.B.); (R.M.-I.); (J.C.)
- Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), 08003 Barcelona, Spain
| | - Sergio Moreno-Fornés
- Center for Epidemiological Studies of Sexually Transmitted Diseases and HIV/AIDS in Catalonia (CEEISCAT), Department of Health, Government of Catalunya, 08916 Badalona, Spain; (J.R.-U.); (L.A.); (Y.D.); (S.M.-F.); (J.A.); (A.B.); (R.M.-I.); (J.C.)
- Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), 08003 Barcelona, Spain
| | - Jordi Aceiton
- Center for Epidemiological Studies of Sexually Transmitted Diseases and HIV/AIDS in Catalonia (CEEISCAT), Department of Health, Government of Catalunya, 08916 Badalona, Spain; (J.R.-U.); (L.A.); (Y.D.); (S.M.-F.); (J.A.); (A.B.); (R.M.-I.); (J.C.)
- Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| | - Andreu Bruguera
- Center for Epidemiological Studies of Sexually Transmitted Diseases and HIV/AIDS in Catalonia (CEEISCAT), Department of Health, Government of Catalunya, 08916 Badalona, Spain; (J.R.-U.); (L.A.); (Y.D.); (S.M.-F.); (J.A.); (A.B.); (R.M.-I.); (J.C.)
- Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), 08003 Barcelona, Spain
- Departament de Pediatria, d’Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Raquel Martín-Iguacel
- Center for Epidemiological Studies of Sexually Transmitted Diseases and HIV/AIDS in Catalonia (CEEISCAT), Department of Health, Government of Catalunya, 08916 Badalona, Spain; (J.R.-U.); (L.A.); (Y.D.); (S.M.-F.); (J.A.); (A.B.); (R.M.-I.); (J.C.)
- Department of Infectious Diseases, Odense University Hospital, 5000 Odense, Denmark
| | - Arkaitz Imaz
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-(IDIBELL), 08907 L’Hospitalet de Llobregat, Spain;
| | | | - Ramón W. Román
- Agència de Qualitat i Avaluació Sanitàries de Catalunya, 08005 Barcelona, Spain;
| | - Paula Suanzes
- Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute (VHIR), 08035 Barcelona, Spain;
| | - Juan Ambrosioni
- Hospital Clínic-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain; (J.A.); (J.M.M.)
- CIBERINFEC, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Jordi Casabona
- Center for Epidemiological Studies of Sexually Transmitted Diseases and HIV/AIDS in Catalonia (CEEISCAT), Department of Health, Government of Catalunya, 08916 Badalona, Spain; (J.R.-U.); (L.A.); (Y.D.); (S.M.-F.); (J.A.); (A.B.); (R.M.-I.); (J.C.)
- Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), 08003 Barcelona, Spain
- Departament de Pediatria, d’Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Jose M. Miro
- Hospital Clínic-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain; (J.A.); (J.M.M.)
- CIBERINFEC, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Josep M. Llibre
- Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain;
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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.
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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
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6
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Kim JYH, Barth SK, Monroe AK, Ahsan S, Kovacic J, Senn S, Castel AD. The impact of COVID-19 on the HIV continuum of care: challenges, innovations, and opportunities. Expert Rev Anti Infect Ther 2023; 21:831-846. [PMID: 37470436 DOI: 10.1080/14787210.2023.2239503] [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: 04/05/2023] [Revised: 06/23/2023] [Accepted: 07/18/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION In February 2019, the United States (US) launched the Ending the HIV Epidemic (EHE) initiative with emphasis on improving the various steps of the Human Immunodeficiency Virus (HIV) prevention and care continuum. However, in March 2020, the Coronavirus Disease 2019 (COVID-19) pandemic was declared, curtailing efforts to end the epidemic in the US. AREAS COVERED To describe the impact of the pandemic on EHE in the US, the authors performed a comprehensive literature review focusing on outcomes at each step of the HIV care continuum. Simultaneously, they identified examples of pandemic-era innovations that may help EHE. EXPERT OPINION Numerous studies demonstrated pandemic-related disruptions across the care continuum as well as the impact on preexisting barriers to care among People with HIV (PWH) at higher risk for poor outcomes. As the pandemic progressed, innovative approaches to delivering healthcare and providing essential services emerged, including widespread use of telemedicine, expansion of home-based care, self-collected sexually transmitted infection (STI) and HIV testing, and co-located testing for COVID-19 and HIV/STIs. While the COVID-19 pandemic initially hindered achieving EHE in the US, the ability to be agile, flexible, and creative led to innovation in HIV care delivery that may ultimately assist in meeting EHE goals as we transition into the post-pandemic era.
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Affiliation(s)
- Jenny Yeon Hee Kim
- Department of Global Health, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 4th Floor, Washington, DC, 20052, USA
| | - Shannon K Barth
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Anne K Monroe
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Sarah Ahsan
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Janja Kovacic
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Siena Senn
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Amanda D Castel
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
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7
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Guo S, Zhang J, Yang X, Weissman S, Olatosi B, Patel RC, Li X. Impact of HIV on COVID-19 Outcomes: A Propensity Score Matching Analysis with Varying Age Differences. AIDS Behav 2023:10.1007/s10461-023-04088-y. [PMID: 37289345 PMCID: PMC10249542 DOI: 10.1007/s10461-023-04088-y] [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: 05/15/2023] [Indexed: 06/09/2023]
Abstract
To exploratorily test (1) the impact of HIV and aging process among PLWH on COVID-19 outcomes; and (2) whether the effects of HIV on COVID-19 outcomes differed by immunity level. The data used in this study was retrieved from the COVID-19 positive cohort in National COVID Cohort Collaborative (N3C). Multivariable logistic regression models were conducted on populations that were matched using either exact matching or propensity score matching (PSM) with varying age difference between PLWH and non-PLWH to examine the impact of HIV and aging process on all-cause mortality and hospitalization among COVID-19 patients. Subgroup analyses by CD4 counts and viral load (VL) levels were conducted using similar approaches. Among the 2,422,864 adults with a COVID-19 diagnosis, 15,188 were PLWH. PLWH had a significantly higher odds of death compared to non-PLWH until age difference reached 6 years or more, while PLWH were still at an elevated risk of hospitalization across all matched cohorts. The odds of both severe outcomes were persistently higher among PLWH with CD4 < 200 cells/mm3. VL ≥ 200 copies/ml was only associated with higher hospitalization, regardless of the predefined age differences. Age advancement in HIV might significantly contribute to the higher risk of COVID-19 mortality and HIV infection may still impact COVID-19 hospitalization independent of the age advancement in HIV.
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Affiliation(s)
- Siyuan Guo
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xueying Yang
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Sharon Weissman
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Bankole Olatosi
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Rena C Patel
- Departments of Medicine and Global Health, University of Washington, Seattle, WA, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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8
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Zsichla L, Müller V. Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors. Viruses 2023; 15:175. [PMID: 36680215 PMCID: PMC9863423 DOI: 10.3390/v15010175] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
The clinical course and outcome of COVID-19 are highly variable, ranging from asymptomatic infections to severe disease and death. Understanding the risk factors of severe COVID-19 is relevant both in the clinical setting and at the epidemiological level. Here, we provide an overview of host, viral and environmental factors that have been shown or (in some cases) hypothesized to be associated with severe clinical outcomes. The factors considered in detail include the age and frailty, genetic polymorphisms, biological sex (and pregnancy), co- and superinfections, non-communicable comorbidities, immunological history, microbiota, and lifestyle of the patient; viral genetic variation and infecting dose; socioeconomic factors; and air pollution. For each category, we compile (sometimes conflicting) evidence for the association of the factor with COVID-19 outcomes (including the strength of the effect) and outline possible action mechanisms. We also discuss the complex interactions between the various risk factors.
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Affiliation(s)
- Levente Zsichla
- Institute of Biology, Eötvös Loránd University, 1117 Budapest, Hungary
- National Laboratory for Health Security, Eötvös Loránd University, 1117 Budapest, Hungary
| | - Viktor Müller
- Institute of Biology, Eötvös Loránd University, 1117 Budapest, Hungary
- National Laboratory for Health Security, Eötvös Loránd University, 1117 Budapest, Hungary
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9
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Hussein AARM, Hashem MK, Azizeldine MG, Shaddad AM. Prevalence and characteristics of COVID-19 vaccine breakthrough infection in Upper Egypt. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2023; 17:21. [PMCID: PMC10120475 DOI: 10.1186/s43168-023-00196-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/28/2023] [Indexed: 12/24/2023] Open
Abstract
Background Infection breakthrough after COVID-19 vaccination is a point of conflict in current literature not only because of the estimation of the potential hazards and symptoms severity but also due to establishing a vaccination policy and measuring the extent of immunity after vaccination in addition to the waning of the humoral immunity over time. To our knowledge, this is the first study to stratify the risk of post-COVID-19 vaccination breakthroughs in Upper Egypt. Methods In this cross-sectional observational study, we enrolled 369 vaccinated patients registered in our facility either admitted or in out-patient clinic. Patients were interviewed and any proven history of COVID-19 infection after vaccination was recorded. Results In the current study, 18.97% (70 patients) of the 369 subjects enrolled in the study had COVID-19breakthrough infection. Students were the high-risk group representing 18.6% of the study subjects. Hypertension, diabetes, and cardiac disease were the most comorbidities associated with a prevalence of 15.7%, 8.6%, and 4.3% respectively. Prior to COVID-19, confirmed infection was present in 42.9% of the study group. Fever, headache, myalgia, and cough were among the most common symptoms of the post-COVID vaccination breakthrough with a prevalence of 90%, 75.7%, 84.3%, and 74.3% respectively. Conclusion Breakthrough infection after COVID-19 vaccination is not uncommon. Most cases are mild and don’t require hospitalization. All types of vaccines tested in the current study offer adequate immunity and guard against severe COVID-19 infection. We encourage the current global policy of full vaccination. Trial registration ClinicalTrials.gov. NCT05033834. Registered September 5, 2021. COVID-19 Infection in After Vaccination-Full Text View-ClinicalTrials.gov.
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Affiliation(s)
- Aliae A. R. Mohamed Hussein
- Chest Department, Assiut University Hospital, Assiut Faculty of Medicine, Assiut University, Assiut, 71515 Egypt
| | - Maiada K. Hashem
- Chest Department, Assiut University Hospital, Assiut Faculty of Medicine, Assiut University, Assiut, 71515 Egypt
| | - Mohammed G. Azizeldine
- Chest Department, Assiut University Hospital, Assiut Faculty of Medicine, Assiut University, Assiut, 71515 Egypt
| | - Ahmad M. Shaddad
- Chest Department, Assiut University Hospital, Assiut Faculty of Medicine, Assiut University, Assiut, 71515 Egypt
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10
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Naylor KL, Kim SJ, Smith G, McArthur E, Kwong JC, Dixon SN, Treleaven D, Knoll GA. Effectiveness of first, second, and third COVID-19 vaccine doses in solid organ transplant recipients: A population-based cohort study from Canada. Am J Transplant 2022; 22:2228-2236. [PMID: 35578576 PMCID: PMC9347443 DOI: 10.1111/ajt.17095] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 01/25/2023]
Abstract
Limited data exists on the effectiveness of a third COVID-19 vaccine dose in solid organ transplant recipients. We conducted a population-based cohort study using linked healthcare databases from Ontario, Canada to answer this question. We included solid organ transplant recipients (n = 12,842) as of December 14, 2020, with follow-up until November 28, 2021. We used an extended Cox proportional hazards model with vaccination status, including BNT162b2, mRNA-1273, and ChAdOx1 vaccines, modeled as a time-dependent exposure. Individuals started in the unvaccinated category (reference) and could contribute person-time to first, second, and third doses. Over a median follow-up of 349 days, 12.7% (n = 1632) remained unvaccinated, 54.1% (n = 6953) received 3 doses, and 488 (3.8%) tested positive for SARS-CoV-2 (of which 260 [53.3%] had a clinically important outcome [i.e., hospitalization or death]). Adjusted vaccine effectiveness against infection was 31% (95% CI: 2, 51%), 46% (95% CI: 21, 63%), and 72% (95% CI: 43, 86%) for one, two, and three doses. Vaccine effectiveness against clinically important outcomes was 38% (95% CI: 4, 61%), 54% (95% CI: 23, 73%), and 67% (95% CI: 11, 87%). Vaccine effectiveness in solid organ transplant recipients is lower than the general population, however, vaccine effectiveness improved following a third dose.
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Affiliation(s)
- Kyla L. Naylor
- ICES Ontario Canada,Department of Epidemiology and Biostatistics Western University London, Ontario Canada,Lawson Health Research Institute, London Health Sciences Centre London, Ontario Canada
| | - Sang Joseph Kim
- ICES Ontario Canada,Division of Nephrology University Health Network, University of Toronto Toronto, Ontario Canada,Institute of Health Policy, Management and Evaluation University of Toronto Toronto, Ontario Canada
| | - Graham Smith
- ICES Ontario Canada,Lawson Health Research Institute, London Health Sciences Centre London, Ontario Canada
| | - Eric McArthur
- ICES Ontario Canada,Lawson Health Research Institute, London Health Sciences Centre London, Ontario Canada
| | - Jeffrey C. Kwong
- ICES Ontario Canada,Institute of Health Policy, Management and Evaluation University of Toronto Toronto, Ontario Canada,Public Health Ontario Toronto, Ontario Canada,Department of Family and Community Medicine and Dalla Lana School of Public Health University of Toronto Toronto, Ontario Canada
| | - Stephanie N. Dixon
- ICES Ontario Canada,Department of Epidemiology and Biostatistics Western University London, Ontario Canada,Lawson Health Research Institute, London Health Sciences Centre London, Ontario Canada
| | - Darin Treleaven
- Transplantation, Trillium Gift of Life Network, Ontario Health Ontario Canada
| | - Gregory A. Knoll
- Department of Medicine (Nephrology) University of Ottawa and the Ottawa Hospital Research Institute Ottawa, Ontario Canada,Gregory A. Knoll, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada.
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11
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Favara G, Barchitta M, Maugeri A, Faro G, Agodi A. HIV infection does not affect the risk of death of COVID-19 patients: A systematic review and meta-analysis of epidemiological studies. J Glob Health 2022; 12:05036. [PMID: 35972980 PMCID: PMC9380965 DOI: 10.7189/jogh.12.05036] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Even during the current Coronavirus Disease 2019 (COVID-19) pandemic, the infection with the Human Immunodeficiency Virus (HIV) continues to pose a major threat, worldwide. In fact, the World Health Organization (WHO) defined the HIV infection as a risk factor for both severe COVID-19, at hospital admission, and in-hospital mortality. Despite this evidence, however, there remains the need for investigating whether SARS-CoV-2 infection could increase the risk of death among people living with HIV (PLHIV). Thus, we conducted a systematic review and meta-analysis to assess the impact of the SARS-CoV-2 infection on the risk of death among PLHIV and HIV- seronegative people. Methods The literature search was carried out on PubMed, Embase and Web of Science databases, from the inception to February 2022. Epidemiological studies on patients tested positive for SARS-CoV-2 infection, which compared the proportion of deaths between PLHIV and HIV-seronegative people, were considered eligible for the inclusion. The pooled odds ratio (OR) was obtained through meta-analysis of the comparison between PLHIV and HIV-seronegative people. Study quality was assessed by using the Newcastle-Ottawa Quality Assessment. Results On a total of 1001 records obtained from the literature search, the present systematic review and meta-analysis included 28 studies on 168 531 PLHIV and 66 712 091 HIV-seronegative patients with SARS-CoV-2 infection. The meta-analysis showed no difference in the risk of death between PLHIV and HIV-seronegative patients (OR = 1.09; 95% confidence interval (CI) = 0.93-1.26; P > 0.001). However, a significant heterogeneity was found for this comparison (I2 = 88.8%, P < 0.001). Conclusions Although our meta-analysis suggests no difference in the risk of death of PLHIV with SARS-CoV-2 infection, if compared with HIV-seronegative patients, further research should be encouraged to improve the current knowledge about the impact of SARS-CoV-2 and HIV co-infection.
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12
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Factors associated with SARS-CoV-2-related hospital outcomes among and between persons living with and without diagnosed HIV infection in New York State. PLoS One 2022; 17:e0268978. [PMID: 35613145 PMCID: PMC9132290 DOI: 10.1371/journal.pone.0268978] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/11/2022] [Indexed: 11/19/2022] Open
Abstract
Background Persons living with diagnosed HIV (PLWDH) are at increased risk for severe illness due to COVID-19. The degree to which this due to HIV infection, comorbidities, or other factors remains unclear. Methods We conducted a retrospective matched cohort study of individuals hospitalized with COVID-19 in New York State between March and June 2020, during the first wave of the pandemic, to compare outcomes among 853 PLWDH and 1,621 persons without diagnosed HIV (controls). We reviewed medical records to compare sociodemographic and clinical characteristics at admission, comorbidities, and clinical outcomes between PLWDH and controls. HIV-related characteristics were evaluated among PLWDH. Results PLWDH were significantly more likely to have cardiovascular (matched prevalence-ratio [mPR], 1.22 [95% CI, 1.07–1.40]), chronic liver (mPR, 6.71 [95% CI, 4.75–9.48]), chronic lung (mPR, 1.76 [95% CI, 1.40–2.21]), and renal diseases (mPR, 1.77 [95% CI, 1.50–2.09]). PLWDH were less likely to have elevated inflammatory markers upon hospitalization. Relative to controls, PLWDH were 15% less likely to require mechanical ventilation or extracorporeal membrane oxygenation (ECMO) and 15% less likely to require admission to the intensive care unit. No significant differences were found in in-hospital mortality. PLWDH on tenofovir-containing regimens were significantly less likely to require mechanical ventilation or ECMO (risk-ratio [RR], 0.73 [95% CI, 0.55–0.96]) and to die (RR, 0.74 [95% CI, 0.57–0.96]) than PLWDH on non-tenofovir-containing regimens. Conclusions While hospitalized PLWDH and controls had similar likelihood of in-hospital death, chronic disease profiles and degree of inflammation upon hospitalization differed. This may signal different mechanisms leading to severe COVID-19.
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13
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Tang ME, Gaufin T, Anson R, Zhu W, Mathews WC, Cachay ER. People with HIV have a higher risk of COVID-19 diagnosis but similar outcomes to the general population. HIV Med 2022; 23:1069-1077. [PMID: 35394110 PMCID: PMC9111643 DOI: 10.1111/hiv.13312] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/21/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND We investigated the effect of HIV on COVID-19 outcomes with attention to selection bias due to differential testing and comorbidity burden. METHODS This was a retrospective cohort analysis using four hierarchical outcomes: positive SARS-CoV-2 test, COVID-19 hospitalization, intensive care unit (ICU) admission and hospital mortality. The effect of HIV status was assessed using traditional covariate-adjusted, inverse probability-weighted (IPW) analysis based on covariate distributions for testing bias (testing IPWs), HIV infection status (HIV-IPWs) and combined models. Among people living with HIV (PWH), we evaluated whether CD4 count and HIV plasma viral load (pVL) discriminated between those who did and those who did not develop study outcomes using receiver operating characteristic analysis. RESULTS Between March and November 2020, 63 319 people were receiving primary care services at the University of California San Diego (UCSD), of whom 4017 were PWH. The PWH had 2.1 times the odds of a positive SARS-CoV-2 test compared with those without HIV after weighting for potential testing bias, comorbidity burden and HIV-IPW [95% confidence interval (CI): 1.6-2.8]. Relative to people without HIV, PWH did not have an increased rate of COVID-19 hospitalization after controlling for comorbidities and testing bias [adjusted incidence rate ratio (aIRR) = 0.5, 95% CI: 0.1-1.4]. PWH did not have a different rate of ICU admission (aIRR = 1.08, 95% CI: 0.31-3.80) or of in-hospital death (aIRR = 0.92, 95% CI: 0.08-10.94) in any examined model. Neither CD4 count nor pVL predicted any of the hierarchical outcomes among PWH. CONCLUSIONS People living with HIV have a higher risk of COVID-19 diagnosis than those without HIV but the outcomes are similar in both groups.
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Affiliation(s)
- Michael E Tang
- University of California San Diego, San Diego, California, USA
| | | | - Ryan Anson
- University of California San Diego, San Diego, California, USA
| | - Wenhong Zhu
- University of California San Diego, San Diego, California, USA
| | | | - Edward R Cachay
- University of California San Diego, San Diego, California, USA
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14
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Kouhpayeh H, Ansari H. HIV infection and increased risk of COVID-19 mortality: A Meta-Analysis. Eur J Transl Myol 2021; 31. [PMID: 34962366 PMCID: PMC8758963 DOI: 10.4081/ejtm.2021.10107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/04/2021] [Indexed: 11/23/2022] Open
Abstract
There are some concerns on the effect of infection with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) on the outcome and mortality of COVID- 19. In this meta-analysis, we aimed to address this issue and assess the risk of mortality in COVID-19 patients who are co-infected with HIV. Two International electronic databases (PubMed, Scopus) were searched from the first time available to 12 August 2021. The targeted outcome was the pooled odds ratio to examine the effect of HIV infection on COVID-19 mortality. The crude odds ratio (OR) for all studies and the pooled OR were calculated with 95% confidence interval. The forest plot was used to graphically represent the result of conducted meta-analysis and calculated OR for individual studies. The I2 statistic was used to examine the Heterogeneity in the included studies. Eleven studies were included in our study consisting of 19,642,775 COVID-19 infected cases, 59,980 HIV-positive, and 4,373 deaths due to COVID-19 in HIV positive patients. The overall pooled odds ratio was 1.21 (CI: 1.02; 1.43) and P-value < 0.0277. The I^2 value was 89% (P-value < 0.0001), which shows that included studies are heterogeneous. In this study, the funnel plot analysis showed symmetry among the included studies. HIV-positive patients are 21% more likely to die because of COVID-19 infection than people without HIV. Special attention should be considered for the prevention and treatment of COVID-19 and consistent treatment for HIV infection, in HIV-positive patients.
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Affiliation(s)
- Hamidreza Kouhpayeh
- Tropical and Infectious Diseases Department, Zahedan University of Medical Sciences, Zahedan, Iran; Zahedan University of Medical Sciences Research Center, Emam Ali Hospital, Zahedan.
| | - Hossein Ansari
- Health Promotion Research Center, Department of Epidemiology and Biostatistics, Zahedan University of Medical Sciences, Zahedan.
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15
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Shapiro AE, Bender Ignacio RA, Whitney BM, Delaney JA, Nance RM, Bamford L, Wooten D, Keruly JC, Burkholder G, Napravnik S, Mayer KH, Webel AR, Kim HN, Van Rompaey SE, Christopoulos K, Jacobson J, Karris M, Smith D, Johnson MO, Willig A, Eron JJ, Hunt P, Moore RD, Saag MS, Mathews WC, Crane HM, Cachay ER, Kitahata MM. Factors associated with severity of COVID-19 disease in a multicenter cohort of people with HIV in the United States, March-December 2020. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.10.15.21265063. [PMID: 34704092 PMCID: PMC8547524 DOI: 10.1101/2021.10.15.21265063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Understanding the spectrum of SARS-CoV-2 infection and COVID-19 disease in people with HIV (PWH) is critical to provide clinical guidance and implement risk-reduction strategies. OBJECTIVE To characterize COVID-19 in PWH in the United States and identify predictors of disease severity. DESIGN Observational cohort study. SETTING Geographically diverse clinical sites in the CFAR Network of Integrated Clinical Systems (CNICS). PARTICIPANTS Adults receiving HIV care through December 31, 2020. MEASUREMENTS COVID-19 cases and severity (hospitalization, intensive care, death). RESULTS Of 16,056 PWH in care, 649 were diagnosed with COVID-19 between March-December 2020. Case fatality was 2%; 106 (16.3%) were hospitalized and 12 died. PWH with current CD4 count <350 cells/mm 3 (aRR 2.68; 95%CI 1.93-3.71; P<.001) or lowest recorded CD4 count <200 (aRR 1.67; 95%CI 1.18-2.36; P<.005) had greater risk of hospitalization. HIV viral load suppression and antiretroviral therapy (ART) status were not associated with hospitalization, although the majority of PWH were suppressed (86%). Black PWH were 51% more likely to be hospitalized with COVID-19 compared to other racial/ethnic groups (aRR 1.51; 95%CI 1.04-2.19, P=.03). Chronic kidney disease (CKD), chronic obstructive pulmonary disease, diabetes, hypertension, obesity, and increased cardiovascular and hepatic fibrosis risk scores were associated with higher risk of hospitalization. PWH who were older, not on ART, with current CD4 <350, diabetes, and CKD were overrepresented amongst PWH who required intubation or died. LIMITATIONS Unable to compare directly to persons without HIV; underestimate of total COVID-19 cases. CONCLUSIONS PWH with CD4 <350 cells/mm 3 , low CD4/CD8 ratio, and history of CD4 <200, have a clear excess risk of severe COVID-19, after accounting for comorbidities also associated with severe outcomes. PWH with these risk factors should be prioritized for COVID-19 vaccination, early treatment, and monitored closely for worsening illness.
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16
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Lee MJ, Snell LB, Douthwaite ST, Fidler S, Fitzgerald N, Goodwin L, Hamzah L, Kulasegaram R, Lawrence S, Lwanga J, Marchant R, Orkin C, Palfreeman A, Parthasarathi P, Pareek M, Ring K, Sharaf H, Shekarchi-Khanghahi E, Simons R, Teh JJ, Thornhill J, van Halsema C, Williamson M, Wiselka M, Nori A, Fox J, Smith C. 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). HIV Med 2021; 23:121-133. [PMID: 34555242 PMCID: PMC8652703 DOI: 10.1111/hiv.13174] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/03/2021] [Indexed: 01/01/2023]
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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Affiliation(s)
- Ming Jie Lee
- Department of Infectious Disease, Imperial College London, London, UK.,Harrison Wing, Guys' and St Thomas' NHS Foundation Trust, London, UK.,Imperial College Healthcare NHS Trust, London, UK
| | - Luke Blagdon Snell
- Centre for Clinical Infection & Diagnostics Research, King's College London, London, UK
| | - Sam T Douthwaite
- Department of Virology, Guys' and St Thomas' NHS Foundation Trust, London, UK
| | - Sarah Fidler
- Department of Infectious Disease, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK
| | - Naomi Fitzgerald
- Harrison Wing, Guys' and St Thomas' NHS Foundation Trust, London, UK
| | | | - Lisa Hamzah
- Department of HIV, St George's Hospital, London, UK
| | | | | | - Julianne Lwanga
- Harrison Wing, Guys' and St Thomas' NHS Foundation Trust, London, UK
| | | | | | | | | | | | - Kyle Ring
- Imperial College Healthcare NHS Trust, London, UK
| | - Hamed Sharaf
- North Manchester General Hospital, Manchester, UK
| | | | - Rebecca Simons
- Harrison Wing, Guys' and St Thomas' NHS Foundation Trust, London, UK
| | - Jhia Jiat Teh
- Department of Infectious Disease, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK
| | | | | | | | | | - Achyuta Nori
- Harrison Wing, Guys' and St Thomas' NHS Foundation Trust, London, UK
| | - Julie Fox
- Harrison Wing, Guys' and St Thomas' NHS Foundation Trust, London, UK
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