Background

Factors affecting outcomes of SARS-CoV-2 infection in people living with HIV are unclear. We assessed the factors associated with SARS-CoV-2 diagnosis and severe outcomes among people living with HIV.

Methods

We did a retrospective cohort study using data from the PISCIS cohort of people with HIV in Catalonia (Spain) between March 1 and Dec 15, 2020. We linked PISCIS data with integrated health-care, clinical, and surveillance registries through the Public Data Analysis for Health Research and Innovation Program of Catalonia (PADRIS) to obtain data on SARS-CoV-2 diagnosis, chronic comorbidities, as well as clinical and mortality outcomes. Participants were aged at least 16 years in care at 16 hospitals in Catalonia. Factors associated with SARS-CoV-2 diagnoses and severe outcomes were assessed using univariable and multivariable Cox regression models. We estimated the effect of immunosuppression on severe outcomes (hospital admission for >24 h with dyspnoea, tachypnoea, hypoxaemia, asphyxia, or hyperventilation; or death) using Kaplan-Meier survival analysis.

Findings

We linked 20 847 (72·8%) of 28 666 participants in the PISCIS cohort with PADRIS data; 13 142 people had HIV. 749 (5·7%) people with HIV were diagnosed with SARS-CoV-2: their median age was 43·5 years (IQR 37·0–52·7), 131 (17·5%) were female, and 618 (82·5%) were male. 103 people with HIV (13·8%) were hospitalised, seven (0·9%) admitted to intensive care, and 13 (1·7%) died. SARS-CoV-2 diagnosis was more common among migrants (adjusted hazard ratio 1·55, 95% CI 1·31–1·83), men who have sex with men (1·42, 1·09–1·86), and those with four or more chronic comorbidities (1·46, 1·09–1·97). Age at least 75 years (5·2, 1·8–15·3), non-Spanish origin (2·1, 1·3–3·4), and neuropsychiatric (1·69, 1·07–2·69), autoimmune disease (1·92, 1·14–3·23), respiratory disease (1·84, 1·09–3·09), and metabolic disease (2·59, 1·59–4·23) chronic comorbidities were associated with increased risk of severe outcomes. A Kaplan-Meier estimator showed differences in the risk of severe outcomes according to CD4 cell count in patients with detectable HIV RNA (p=0·039) but no differences were observed in patients with undetectable HIV RNA (p=0·15).

Interpretation

People living with HIV with detectable HIV viraemia, chronic comorbidities, and some subpopulations could be at increased risk of severe outcomes from COVID-19. These groups should be prioritised in clinical management and SARS-CoV-2 vaccination programmes.

Funding

Fundació “la Caixa”.

Translations

For the Catalan, Spanish and Russian translations of the Summary see Supplementary Materials section.

中文翻译：

---

与 SARS-CoV-2 诊断和 HIV 感染者严重 COVID-19 结果相关的社会人口学、临床和免疫学因素：一项回顾性队列研究

背景

影响 SARS-CoV-2 感染 HIV 感染者结局的因素尚不清楚。我们评估了与 SARS-CoV-2 诊断和 HIV 感染者严重后果相关的因素。

方法

我们使用 2020 年 3 月 1 日至 12 月 15 日期间来自加泰罗尼亚（西班牙）的 PI​​SCIS HIV 感染者队列的数据进行了一项回顾性队列研究。我们通过公共数据分析将 PISCIS 数据与综合医疗保健、临床和监测登记处联系起来加泰罗尼亚卫生研究与创新计划 (PADRIS) 获取有关 SARS-CoV-2 诊断、慢性合并症以及临床和死亡率结果的数据。参与者年龄至少 16 岁，在加泰罗尼亚的 16 家医院接受护理。使用单变量和多变量 Cox 回归模型评估与 SARS-CoV-2 诊断和严重后果相关的因素。我们评估了免疫抑制对严重后果的影响（因呼吸困难、呼吸急促、低氧血症、窒息或换气过度入院 >24 小时；

发现

我们将 PISCIS 队列中 28 666 名参与者中的 20 847 (72·8%) 人与 PADRIS 数据联系起来；13 142 人感染了 HIV。749 名 (5·7%) HIV 感染者被诊断为 SARS-CoV-2：他们的中位年龄为 43·5 岁 (IQR 37·0–52·7)，131 (17·5%) 为女性，618 (82·5%) 是男性。103 名 HIV 感染者 (13·8%) 住院，7 名 (0·9%) 接受重症监护，13 名 (1·7%) 死亡。SARS-CoV-2 诊断在移民（调整后风险比 1·55，95% CI 1·31–1·83）、男男性行为者（1·42、1·09–1·86）中更为常见, 以及患有四种或四种以上慢性合并症的患者 (1·46, 1·09–1·97)。年龄至少 75 岁（5·2、1·8–15·3）、非西班牙血统（2·1、1·3–3·4）和神经精神疾病（1·69、1·07–2· 69）、自身免疫性疾病（1·92、1·14–3·23）、呼吸系统疾病（1·84、1·09–3·09）和代谢性疾病（2·59、1·59–4·23) 慢性合并症与严重后果的风险增加有关。根据 CD4 细胞计数，Kaplan-Meier 估计量显示在可检测到 HIV RNA 的患者中严重后果的风险存在差异 (p=0·039)，但在无法检测到 HIV RNA 的患者中未观察到差异 (p=0·15)。

解释

患有可检测到的 HIV 病毒血症的 HIV 感染者、慢性合并症和某些亚群可能因 COVID-19 而面临严重后果的风险增加。在临床管理和 SARS-CoV-2 疫苗接种计划中应优先考虑这些群体。

资金

Fundació “la Caixa”。

翻译

有关摘要的加泰罗尼亚语、西班牙语和俄语翻译，请参阅补充材料部分。