Long COVID Between People With and Without HIV: A Statewide Cohort Analysis

This study aimed to compare the risks of a panel of long COVID (LC) manifestations between people with HIV (PWH) and people without HIV (PWoH).

Using integrated statewide electronic health record data from the HIV cohort and COVID-19 tester cohort, we identified COVID-19-positive individuals by HIV status between March 02, 2020, and January 15, 2022, in South Carolina. A total of 13 diagnosis groups encompassing 131 potential LC categories were identified. We used inverse probability weighting based on propensity scores to balance covariates between the PWH and PWoH, including age, sex, race, and vaccination status. Cox Proportional Hazard regression models were used to estimate the risk of each diagnosis group examined.

Among a total of 838,520 COVID-19-positive individuals, 2662 were with HIV and 835,858 were without HIV. The prevalence of any LC diagnosis was 16.3% and 10.6% for PWH and PWoH, respectively. Compared with PWoH, PWH were found to be at a higher risk of at least one of the LC diagnosis groups (hazard ratio [HR] = 1.29, 95% confidence interval [95% CI]: 1.09 to 1.54) and the highest risk was for diseases of the nervous system (HR = 2.04, 95% CI: 1.42 to 2.92), followed by mental disorders (HR = 1.78, 95% CI: 1.12 to 2.82) and respiratory system (HR = 1.78, 95% CI: 1.18 to 2.69).

Our study highlights the consistent and elevated LC burden in PWH, emphasizing the importance of sustained follow-up for COVID-19 survivors to improve their clinical outcomes and prevent morbidity of LC.