Case-control study of HIV positive people hospitalised with COVID-19
Simon Collins, HIV i-Base
A retrospective case-controlled study from the first months of the pandemic did not find that HIV status was associated with poorer outcomes in people hospitalised with COVID-19.
The RECEDE C-19 study recruited adults from six hospitals (mainly from London but also Leicester and Manchester) from four months early in the pandemic (February to May 2020). HIV negative controls were matched in up to a 3:1 ratio for gender, hospital, date of infection (within a week), age (within five years) and deprivation index (for region) as ethnicity data was poorly recorded.
The primary outcome was time to either improvement by two points on a standard COVID 7-point ordinal scale or hospital discharge, whichever was sooner.
From more than 6600 admissions, 68 HIV positive people were matched to 181 HIV negative controls. At baseline, HIV positive people were significantly more likely to be frail (median frailty score of 3 vs 2, p=0.0069), from Black or minority ethnic communities (75% vs 58%, p=0.0002), to have chronic kidney disease (35% vs 12%, p=0.0001) and to have chronic liver disease (4% vs 0.6%, p=0.031). The HIV negative cohort was more likely to have rheumatology disease or asthma.
In univariate analysis, HIV positive people were less likely to reach the primary outcome, although 28-day mortality was similar.
In the multivariate analysis, after adjusting for comorbidities, duration of symptoms and ethnicity, HIV status was no longer significant (p=0.11), and the impact of frailty (p=0.011) and having an active malignancy (p=0.014) were attenuated. BMI <25 also became significant (p=0.047).
Characteristics of the HIV positive cohort had been HIV positive for a median of 15 years (IQR: 10 to 18), with median CD4 352 cells/mm3 (IQR: 253 to 619) and 97% had viral load <200 copies/mL but five people were not on ART.
The presentation also included results of a planned sub analysis on respiratory bacterial coinfection, that were low in both cohorts but non-significantly higher in the HIV positive group (13% vs 6%, p=0.123). In the HIV positive group, coinfection was not related to hospital duration or 28-day mortality. Conversely, in the HIV negative cohort, coinfection was associated with both longer hospital stay (p=0.0007) and mortality (p=0.002).
It is good to see these results from this carefully conducted study.
However, especially in contrast to the BHIVA registry and PHE mortality studies (see above) the sample size was probably too small to be powered to look at mortality as an endpoint.
Ethnicity might also have affected the results as this was not consistently reported.
Lee M et al. HIV and COVID-19 inpatient outcomes in England during the early pandemic. Joint BHIVA BASHH Spring Conference, 2021. Oral abstract O-007.
(This link should be open access from approximately 20 May 2021).