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COVID-19 Disease Severity Among People With HIV Infection or Solid Organ Transplant in the United States: A Nationally-Representative, Multicenter, Observational Cohort Study

34 Pages Posted: 28 Jul 2021

See all articles by Jing Sun

Jing Sun

Johns Hopkins University - Department of Epidemiology

Rena C. Patel

University of Washington - Department of Medicine

Qulu Zheng

Johns Hopkins University - Department of Epidemiology

Vithal Madhira

Palila Software, LLC

Amy L. Olex

Virginia Commonwealth University

Jessica Y. Islam

H. Lee Moffitt Cancer Center and Research Institute - Center for Immunization and Infection in Cancer

Evan French

Virginia Commonwealth University

Teresa Po-Yu Chiang

Johns Hopkins University

Hana Akselrod

George Washington University - Division of Infectious Diseases

Richard Moffitt

State University of New York (SUNY), Stony Brook

G. Alexander

Johns Hopkins University - Department of Environmental Health Sciences and Epidemiology; Johns Hopkins University - Department of Medicine; Monument Analytics

Kathleen M. Andersen

Johns Hopkins University - Department of Epidemiology

Amanda J. Vinson

Dalhousie University - Department of Nephrology

Todd T. Brown

Johns Hopkins University, School of Medicine, Division of Endocrinology, Diabetes, & Metabolism

Christopher G. Chute

Johns Hopkins University - School of Medicine

Keith A. Crandall

Milken Institute

Nora Franceschini

University of North Carolina (UNC) at Chapel Hill - Department of Epidemiology

Roslyn B. Mannon

University of Nebraska Medical Center - Division of Nephrology

Gregory D. Kirk

Johns Hopkins University - Department of Epidemiology

National COVID Cohort Collaborative (N3C) Consortium

Independent

More...

Abstract

Background: Individuals with immune dysfunction, including people with HIV (PWH) or solid organ transplant recipients (SOT), might have worse outcomes from COVID-19. We compared odds of COVID-19 outcomes between patients with and without immune dysfunction.

Methods: We evaluated data from the National COVID-19 Cohort Collaborative (N3C), a multicenter retrospective cohort of electronic medical record (EMR) data from across the United States, on. 1,446,913 adult patients with laboratory-confirmed SARS-CoV-2 infection. HIV, SOT, comorbidity, and HIV markers were identified from EMR data prior to SARS-CoV-2 infection. COVID-19 disease severity within 45 days of SARS-CoV-2 infection was classified into 5 categories: asymptomatic/mild disease with outpatient care; mild disease with emergency department (ED) visit; moderate disease requiring hospitalization; severe disease requiring ventilation or extracorporeal membrane oxygenation (ECMO); and death. We used multivariable, multinomial logistic regression models to compare odds of COVID-19 outcomes between patients with and without immune dysfunction.

Findings: Compared to patients without immune dysfunction, PWH and SOT had a greater likelihood of having ED visits (adjusted odds ratio [aOR]: 1.28, 95% confidence interval [CI] 1.27-1.29; aOR: 2.61, CI: 2.58-2.65, respectively), requiring ventilation or ECMO (aOR: 1.43, CI: 1.43-1.43; aOR: 4.82, CI: 4.78-4.86, respectively), and death (aOR: 1.20, CI: 1.19-1.20; aOR: 3.38, CI: 3.35-3.41, respectively). Associations were independent of sociodemographic and comorbidity burden. Compared to PWH with CD4>500 cells/mm 3 , PWH with CD4<350 cells/mm 3 were independently at 4.4-, 5.4-, and 7.6-times higher odds for hospitalization, requiring ventilation, and death, respectively. Increased COVID-19 severity was associated with higher levels of HIV viremia.

Interpretation: Individuals with immune dysfunction have greater risk for severe COVID-19 outcomes. More advanced HIV disease (greater immunosuppression and HIV viremia) was associated with higher odds of severe COVID-19 outcomes. Appropriate prevention and treatment strategies should be investigated to reduce the higher morbidity and mortality associated with COVID-19 among PWH and SOT.

Funding Information: NCATS U24 TR002306. ALO was supported by CTSA award No. UL1TR002649 from the National Center for Advancing Translational Sciences. Dr. Gregory Kirk is supported in part by NIAID K24AI118591. Dr. Rena C. Patel’s effort was supported by NIAID of the NIH (K23AI120855). Ms. Andersen received doctoral training support from the National Heart, Lung and Blood Institute Pharmacoepidemiology T32 Training Program (T32HL139426). Dr. Todd
Brown is supported in part by NIAID K24AI120834.

Declaration of Interests: None to declare.

Ethics Approval Statement: The N3C Data Enclave is approved under the authority of the NIH Institutional Review Board (IRB, IRB00249128) with Johns Hopkins University School of Medicine as a central IRB for data transfer. Institutional IRB at each study site approved the study protocol or ceded to this single IRB. The current study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines.

Suggested Citation

Sun, Jing and Patel, Rena C. and Zheng, Qulu and Madhira, Vithal and Olex, Amy L. and Islam, Jessica Y. and French, Evan and Chiang, Teresa Po-Yu and Akselrod, Hana and Moffitt, Richard and Alexander, G. Caleb and Andersen, Kathleen M. and Vinson, Amanda J. and Brown, Todd T. and Chute, Christopher G. and Crandall, Keith A. and Franceschini, Nora and Mannon, Roslyn B. and Kirk, Gregory D. and Consortium, National COVID Cohort Collaborative (N3C), COVID-19 Disease Severity Among People With HIV Infection or Solid Organ Transplant in the United States: A Nationally-Representative, Multicenter, Observational Cohort Study. Available at SSRN: https://ssrn.com/abstract=3893539 or http://dx.doi.org/10.2139/ssrn.3893539

Jing Sun (Contact Author)

Johns Hopkins University - Department of Epidemiology ( email )

MD
United States

Rena C. Patel

University of Washington - Department of Medicine ( email )

Box 356340
1925 N.E. Pacific Street
Seattle, WA 98195-6340
United States

Qulu Zheng

Johns Hopkins University - Department of Epidemiology ( email )

MD
United States

Vithal Madhira

Palila Software, LLC ( email )

Reno, NV
United States

Amy L. Olex

Virginia Commonwealth University

301 W Main Street
Richmond, VA 23284
United States

Jessica Y. Islam

H. Lee Moffitt Cancer Center and Research Institute - Center for Immunization and Infection in Cancer ( email )

12902 USF Magnolia Drive
Tampa, FL 33612
United States

Evan French

Virginia Commonwealth University

301 W Main Street
Richmond, VA 23284
United States

Teresa Po-Yu Chiang

Johns Hopkins University

Baltimore, MD 20036-1984
United States

Hana Akselrod

George Washington University - Division of Infectious Diseases ( email )

2121 I Street NW
Washington, DC 20052
United States

Richard Moffitt

State University of New York (SUNY), Stony Brook

Health Science Center
Stony Brook, NY 11794
United States

G. Caleb Alexander

Johns Hopkins University - Department of Environmental Health Sciences and Epidemiology ( email )

Baltimore, MD 21205
United States

Johns Hopkins University - Department of Medicine ( email )

720 Rutland Avenue
Baltimore, MD 21205-2196
United States

Monument Analytics ( email )

Baltimore, MD
United States

Kathleen M. Andersen

Johns Hopkins University - Department of Epidemiology ( email )

MD
United States

Amanda J. Vinson

Dalhousie University - Department of Nephrology ( email )

6225 University Avenue
Halifax, Nova Scotia B3H 4H7
Canada

Todd T. Brown

Johns Hopkins University, School of Medicine, Division of Endocrinology, Diabetes, & Metabolism ( email )

MD
United States

Christopher G. Chute

Johns Hopkins University - School of Medicine ( email )

733 North Broadway
Suite G-49
Baltimore, MD 21205-2196
United States

Keith A. Crandall

Milken Institute

1250 Fourth Street
Santa Monica, CA 90401
United States

Nora Franceschini

University of North Carolina (UNC) at Chapel Hill - Department of Epidemiology ( email )

102 Ridge Road
Chapel Hill, NC NC 27514
United States

Roslyn B. Mannon

University of Nebraska Medical Center - Division of Nephrology ( email )

42nd and Emile
Omaha, NE NE 68198
United States

Gregory D. Kirk

Johns Hopkins University - Department of Epidemiology ( email )

MD
United States

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