Background
Since the beginning of the COVID-19 pandemic, many have been concerned that people with HIV (PWH) might encounter a more severe course of COVID-19 than the people without HIV due to the impaired inflammatory cell responses in PWH, leading to more complications and death.
In PWH, barriers such as mental illness, drug abuse, homelessness, alcohol consumption have increased the risk of COVID-19 infection and negatively impacted access to healthcare. Further, before the widespread use of COVID-19 vaccination, PWH were two times at risk for severe acute respiratory syndrome 2 (SARS-CoV-2) infection than those without HIV.
Although several studies have tried to demonstrate the effects of HIV on COVID-19, they lacked appropriate control for potential collider bias.
The study
The present retrospective study was conducted at the University of California San Diego (UCSD) Health in those 18 years or older and receiving primary care service between March 1, 2020, and November 30, 2020.
All adults who tested SARS-CoV-2-positive were included in the study. Those who received treatment for any COVID-19-related illness from facilities outside UCSD were excluded to eliminate system differences in management practices.
Based on four hierarchical outcomes: SARS-CoV-2 diagnosis, COVID-19-associated hospitalization, intensive care unit (ICU) admission, and in-hospital death, the impact of HIV on COVID-19 outcomes was determined.
The HIV status impact on SARS-CoV-2 infection was analyzed using inverse probability weighted (IPW) analysis based on covariate distributions for testing bias (testing IPWs), HIV infection status (HIV IPWs), traditional covariate-adjusted, and combined models.
The researchers also determined whether the HIV plasma viral load (pVL) and CD4 count predicted the risk of COVID-19 outcomes among the PWH, using receiver operating characteristic (ROC) analysis.
