BACKGROUND: It is unknown whether people living with HIV (PLWH) are at greater risk for adverse outcomes due to COVID-19 than people without HIV infection or if, among PLWH, outcomes are associated with CD4 count and viral suppression (VS). Bronx County in New York City is an epicenter of both the HIV epidemic and COVID-19 in the United States.
METHODS: We conducted a retrospective cohort study of SARS-CoV-2 PCR-positive patients admitted to a large tertiary academic health system in the Bronx, New York between March 10 and May 11, 2020. HIV-related data came from the Einstein-Rockefeller-CUNY Center for AIDS Research Clinical Cohort Database[DH1] . Outcomes assessed were in-hospital intubation, acute kidney injury (AKI), mortality, and length of stay (LOS). To compare outcomes between PLWH and those without HIV infection we used multivariable regression models, adjusting for age, gender, and race/ethnicity. Outcomes were explored among PLWH according to CD4 count and VS.
RESULTS: Among 4,662 patients, median age (IQR) was 65 (54-76); 47% were female. Most were either non-Hispanic Black (36%) or Hispanic (37%), and 80% had public health insurance. Overall, 77 (1.7%) were PLWH, among whom the most recent HIV viral load was undetectable (<40 copies/mL) in 83%; most recent CD4 was <200 cells/uL in 16%, 200-499 cells/uL in 44%), and '¥500 cells/uL in 40%. Overall, 10/77 (13%) PLWH and 634/4585 (14%) without HIV were intubated, and 29/77 (38%) PLWH and 1881/4585 (41%) without HIV developed AKI. In-hospital mortality was 14/77 (18%) among PLWH and 1037/4585 (23%) among those without HIV. Hospital LOS was 5 days (3-9) for both PLWH and those without HIV who were discharged. HIV status was not significantly associated with mortality, intubation, AKI or LOS. In exploratory analyses among PLWH with CD4 count available (N=73), higher CD4 count was associated with intubation (adjusted odds ratio 1.36 per 100 cells/uL, 95% CI 1.02-1.82). None of the 10 viremic PLWH were intubated, versus 10/57 (18%) among suppressed PLWH.
CONCLUSIONS: In hospitalized patients with COVID-19, there were no significant differences in intubation, AKI, mortality, and LOS between PLWH and without HIV. Our preliminary findings regarding intubation among PLWH warrant further examination.