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Bender Ignacio RA, Shapiro AE, Nance RM, Whitney BM, Delaney J, Bamford L, Wooten D, Karris M, Mathews WC, Kim HN, Van Rompaey SE, Keruly JC, Burkholder G, Napravnik S, Mayer KH, Jacobson J, Saag MS, Moore RD, Eron JJ, Willig AL, Christopoulos KA, Martin J, Hunt PW, Crane HM, Kitahata MM, Cachay E. Racial and ethnic disparities in COVID-19 disease incidence independent of comorbidities, among people with HIV in the US. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.12.07.21267296. [PMID: 34909782 PMCID: PMC8669849 DOI: 10.1101/2021.12.07.21267296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To define the incidence of clinically-detected COVID-19 in people with HIV (PWH) in the US and evaluate how racial and ethnic disparities, comorbidities, and HIV-related factors contribute to risk of COVID-19. DESIGN Observational study within the CFAR Network of Integrated Clinical Systems cohort in 7 cities during 2020. METHODS We calculated cumulative incidence rates of COVID-19 diagnosis among PWH in routine care by key characteristics including race/ethnicity, current and lowest CD4 count, and geographic area. We evaluated risk factors for COVID-19 among PWH using relative risk regression models adjusted with disease risk scores. RESULTS Among 16,056 PWH in care, of whom 44.5% were Black, 12.5% were Hispanic, with a median age of 52 years (IQR 40-59), 18% had a current CD4 count < 350, including 7% < 200; 95.5% were on antiretroviral therapy, and 85.6% were virologically suppressed. Overall in 2020, 649 PWH were diagnosed with COVID-19 for a rate of 4.94 cases per 100 person-years. The cumulative incidence of COVID-19 was 2.4-fold and 1.7-fold higher in Hispanic and Black PWH respectively, than non-Hispanic White PWH. In adjusted analyses, factors associated with COVID-19 included female sex, Hispanic or Black identity, lowest historical CD4 count <350 (proxy for CD4 nadir), current low CD4/CD8 ratio, diabetes, and obesity. CONCLUSIONS Our results suggest that the presence of structural racial inequities above and beyond medical comorbidities increased the risk of COVID-19 among PWHPWH with immune exhaustion as evidenced by lowest historical CD4 or current low CD4:CD8 ratio had greater risk of COVID-19.
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Affiliation(s)
- R A Bender Ignacio
- University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Research Center
| | - A E Shapiro
- University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Research Center
| | - R M Nance
- University of Washington, Seattle, WA, USA
| | | | | | - L Bamford
- University of California San Diego, San Diego, CA, USA
| | - D Wooten
- University of California San Diego, San Diego, CA, USA
| | - M Karris
- University of California San Diego, San Diego, CA, USA
| | - W C Mathews
- University of California San Diego, San Diego, CA, USA
| | - H N Kim
- University of Washington, Seattle, WA, USA
| | | | - J C Keruly
- Johns Hopkins School of Medicine, Baltimore, MD
| | - G Burkholder
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - S Napravnik
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - K H Mayer
- Fenway Health and Harvard Medical School, Boston, MA, USA
| | - J Jacobson
- Case Western Reserve University, Cleveland, OH, USA
| | - M S Saag
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - R D Moore
- Johns Hopkins School of Medicine, Baltimore, MD
| | - J J Eron
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A L Willig
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - J Martin
- University of California, San Francisco, San Francisco, CA, USA
| | - P W Hunt
- University of California, San Francisco, San Francisco, CA, USA
| | - H M Crane
- University of Washington, Seattle, WA, USA
| | | | - E Cachay
- University of California San Diego, San Diego, CA, USA
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Martín-Vicente M, Berenguer J, Muñoz-Gómez MJ, Díez C, Micán R, Pérez-Elías MJ, García-Fraile LJ, Peraire J, Suárez-García I, Jiménez-Sousa MÁ, Fernández-Rodríguez A, Vázquez M, Ryan P, González-García J, Jarrín I, Mas V, Martínez I, Resino S. Similar humoral immune responses against the SARS-CoV-2 spike protein in HIV and non-HIV individuals after COVID-19. J Infect 2021; 84:418-467. [PMID: 34752819 PMCID: PMC8574204 DOI: 10.1016/j.jinf.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 11/23/2022]
Affiliation(s)
- María Martín-Vicente
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain..
| | - Juan Berenguer
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.; Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain.
| | - María José Muñoz-Gómez
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain..
| | - Cristina Díez
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.; Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain.
| | - Rafael Micán
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.; Servicio de Medicina Interna, Hospital Universitario La Paz, IdiPaz, Madrid, Spain.
| | - María Jesús Pérez-Elías
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.; Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain.
| | - Lucio Jesús García-Fraile
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.; Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, Spain.
| | - Joaquin Peraire
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.; Servicio de Medicina Interna, Hospital Universitari de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain..
| | - Inés Suárez-García
- Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain; Universidad Europea, Villaviciosa de Odón, Madrid, Spain..
| | - María Ángeles Jiménez-Sousa
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain..
| | - Amanda Fernández-Rodríguez
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain..
| | - Mónica Vázquez
- Unidad de Biología Viral, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain.
| | - Pablo Ryan
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.; Servicio de Medicina Interna, Hospital Infanta Leonor, IiSGM, Madrid, Spain.
| | - Juan González-García
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.; Servicio de Medicina Interna, Hospital Universitario La Paz, IdiPaz, Madrid, Spain.
| | - Inmaculada Jarrín
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.; Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain.
| | - Vicente Mas
- Unidad de Biología Viral, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain.
| | - Isidoro Martínez
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain..
| | - Salvador Resino
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain..
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