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Effect of HIV Status and Charlson Comorbidity Index on COVID-19 Clinical Outcomes in a Case-Control Study
Rebecca C Gerrity1, Melissa Parkinson1, Rachel Strength1
1From the Department of Medicine.
Insights
People living with HIV (PLWH) had similar COVID-19 outcomes compared to controls. However, a higher Charlson Comorbidity Index score significantly increased morbidity and mortality in all patients, irrespective of HIV status.
Area of Science:
- Infectious Diseases
- Public Health
- Virology
Background:
- The COVID-19 pandemic highlighted comorbidities as risk factors for severe illness and death.
- Limited research exists on the impact of human immunodeficiency virus (HIV) co-infection on COVID-19 outcomes.
- Understanding these outcomes is crucial for managing vulnerable populations during global health crises.
Purpose of the Study:
- To compare clinical outcomes of COVID-19 patients with HIV against a matched control group without HIV.
- To investigate the specific impact of HIV status on COVID-19 related morbidity and mortality.
- To assess the influence of comorbidities, such as a high Charlson Comorbidity Index, on COVID-19 outcomes in PLWH.
Main Methods:
- A cohort of 45 people living with HIV (PLWH) admitted with COVID-19 was identified.
- PLWH were matched 1:1 with COVID-19 positive patients without a history of HIV.
- Clinical outcomes were compared between the matched groups, with a sensitivity analysis excluding nine mismatched pairs.
Main Results:
- No significant differences in demographic variables or measured clinical outcomes were observed between PLWH and controls.
- A CD4 count below 200 cells/µL was not associated with increased morbidity or mortality.
- An elevated Charlson Comorbidity Index score (>3) was significantly associated with increased intubation, vasopressor use, ICU admission, mortality, and longer hospital stays, irrespective of HIV status.
Conclusions:
- HIV status alone did not significantly alter COVID-19 outcomes when compared to matched controls.
- The Charlson Comorbidity Index emerged as a critical predictor of severe COVID-19 outcomes.
- Managing comorbidities is essential for improving COVID-19 prognosis, particularly in individuals with underlying health conditions.
Objectives:
During the course of the coronavirus disease 2019 (COVID-19) pandemic, numerous comorbidities were identified as risk factors for increased morbidity and mortality. Few studies have examined human immunodeficiency virus (HIV) and COVID-19 co-infection and the impact of HIV on COVID-19 outcomes. In this study, we compared outcomes of people living with HIV with COVID-19 with a control group to examine outcomes.
Methods:
We identified 45 people living with HIV admitted with COVID-19 to one of three large healthcare systems in Memphis, Tennessee, between March 1 and October 31, 2020. We matched the people living with HIV in a 1:1 fashion to a control group of COVID-19-positive patients without a recorded history of HIV and compared clinical outcomes. Nine pairs were not able to be optimally matched, so a sensitivity analysis was completed by repeating the same analyses in the primary analysis while excluding the nine mismatched pairs.
Results:
Patients did not differ significantly in demographic variables due to the matching algorithm, and there was no significant difference in measured outcomes between people living with HIV and controls. A CD4 count of <200 cells per microliter was not significantly associated with increased morbidity or mortality. Controlling for HIV status, an elevated Charlson Comorbidity Index score of >3 was associated with increased intubation (P = 0.02), vasopressor use (odds ratio [OR] 4.81, P = 0.04), intensive care unit level of care (OR 4.37, P = 0.007), mortality (OR 7.14, P = 0.02), and length of overall hospital stay in days (P = 0.004).
Conclusions:
We found no difference in outcomes of people living with HIV in comparison to matched controls based on HIV status but found that an increased Charlson Comorbidity Index score led to increased morbidity and mortality regardless of HIV status.
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