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COVID-19 Outcomes Among Persons Living With or Without Diagnosed HIV Infection in New York State

Our take —

This study compared SARS-CoV-2 infection, COVID-19 hospitalization, and in-hospital COVID-19 death by HIV status among 19,453,561 people diagnosed with SARS-CoV-2 in New York State from March 1 to June 7, 2020 (108,062 cases among those living with diagnosed HIV). They found that COVID-19 hospitalization and in-hospital death among those diagnosed with SARS-CoV-2 were more common among people living with diagnosed HIV, however, the lack of adjustment for some confounders and their restriction to in-hospital COVID-19 mortality instead of all location COVID-19 mortality makes it difficult to assess COVID-19 mortality among people living with diagnosed HIV.

Study design

Prospective Cohort

Study population and setting

This prospective study included all individuals who tested positive for SARS-CoV-2 from March 1 to June 7, 2020 in New York State (United States). Data from the New York State department of health laboratory registry, which included all individuals with laboratory-confirmed SARS-CoV-2 infection during the study period, were cross-referenced with New York State’s HIV surveillance registry and a public health information system with information on statewide hospitalizations. Participants were classified as living with diagnosed HIV if they were in the HIV surveillance registry as of December 2019; hospitalizations were deemed COVID-19-related if participants were admitted 14 days prior to the period 30 days or less after a positive SARS-CoV-2 test or if a participant tested positive during a hospital encounter; in-hospital deaths were defined by discharge status codes. They assessed SARS-CoV-2 infections, hospitalizations, and in-hospital deaths by history of HIV diagnosis via event rates per 1000 persons, standardized by age, sex, and region on a population level among those who tested positive for SARS-CoV-2 and among those hospitalized with COVID-19.

Summary of Main Findings

During the study period, of the 19,453,561 cases in New York State, 27.7 per 1,000 people living with diagnosed HIV tested positive for SARS-CoV-2 compared to 19.4 per 1,000 people without diagnosed HIV (RR 1.43, 95% CI: 1.38, 1.48); however, after standardizing for age, sex, and region, COVID-19 diagnosis rates were similar regardless of previous HIV diagnosis status (standardized [s]RR 0.94, 95% CI: 0.91-0.97). Of those diagnosed with confirmed SARS-CoV-2 infection, 299.9 per 1,000 people living with diagnosed HIV were hospitalized with COVID-19 compared to 163.5 per 1,000 people without diagnosed HIV (RR 1.83, 95% CI: 1.72, 1.96; sRR 1.47, 95% CI 1.37-1.56), and 69.3 per 1,000 people living with diagnosed HIV died in-hospital from COVID-19 compared to 38.7 per 1,000 people without diagnosed HIV (RR 1.79, 95% CI: 1.56, 2.05; sRR 1.30, 95% CI 1.13-1.48). Among participants hospitalized with COVID-19, 231 per 1,000 people living with diagnosed HIV died in-hospital from COVID-19 compared to 236.6 per 1,000 people without diagnosed HIV (RR 0.98, 95% CI: 0.85, 1.12; sRR 0.96, 95% CI 0.83-1.09).

Study Strengths

This large study presented risk ratios standardized for age, sex, and region that disaggregate the risk for various components of COVID-19 among people living with diagnosed HIV: SARS-CoV-2 infection, COVID-19 hospitalizations, and COVID-19 in-hospital deaths.

Limitations

Although they were able to standardize for age, sex, and region, they did not have sufficient data to adjust for other potential confounders, including occupation, household size, or other medical comorbidities that may increase the likelihood of SARS-CoV-2 infection or COVID-19 hospitalization/deaths. Due to administrative delays, HIV diagnoses from December 2019 to the study start date were not included, which may have undercounted the number of people living with diagnosed HIV and would push the effect estimates towards no difference if they were more likely to be diagnosed with SARS-CoV-2. People living with diagnosed HIV may be more likely to present to the hospital earlier or be admitted when they present, and therefore may be more likely to die in the hospital (rather than at home or elsewhere) compared to those without diagnosed HIV , which would bias the effect away from no difference. Alternatively, if someone living with diagnosed HIV is truly at a higher risk of death from COVID-19 compared to a similar person without diagnosed HIV, this difference may disappear when they are compared to a similar person who was sick enough to be hospitalized for COVID-19. This may explain the difference between in-hospital deaths per diagnosis (higher in people living with diagnosed HIV) and in-hospital deaths per hospitalization (no difference by diagnosed HIV status).

Value added

This study supports recent studies suggesting that people living with HIV may be at a higher risk of death from COVID-19.

This review was posted on: 12 March 2021