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HIV Infection is Associated with Higher Risk of Post-Acute Sequelae of SARS-CoV-2 (PASC) However Vaccination is Protective
19 Pages Posted: 15 Nov 2022
More...Abstract
Background: People with HIV (PWH) are at higher risk of complications from acute COVID-19, but their risk of subsequent post-acute sequelae of SARS-CoV2 (PASC) remains unclear. Although vaccination is protective of PASC among survivors in the general population, its effectiveness in PWH remains unclear.
Methods: We used the TriNetX health research database to identify patients aged ≥18 years with confirmed SARS-CoV-2 between January 1, 2020 and September 16, 2022. We categorized patients by HIV status, demographic characteristics, baseline comorbidities and vaccination status. The primary outcome was risk of PASC, compared by HIV and vaccination status after 1:1 propensity score matching. PASC was defined as persistence or occurrence of new-onset health conditions at least 28 days following COVID-19.
Results: Of 3,048,792 people with confirmed SARS-CoV-2 infection, 1% (n=28,904) were PWH, with 9% of PWH (n=2592) vaccinated. At 28 days post-COVID-19 diagnosis, PWH had lower mortality compared with their non-HIV counterparts (OR 0.78, 95% CI 0.70-0.87), but higher risk of developing new-onset diabetes (DM) (OR 1·26, 95% CI 1·11-1·42), heart disease (OR 1·27, 95% 1·14-1·41), malignancy (OR 1·66, 95% CI 1·45-1·89), thrombosis (OR 1·25, 95% CI 1·12-1·39) and mental health disorders (OR 1·70 (95% CI 1·53-1·90). Furthermore, vaccinated PWH had significantly lower odds of death (OR 0·63, 95% CI 0·42-0·93) and each new-onset PASC outcome, as follows: DM (OR 0·51, 95% CI 0·32-0·82), heart disease (OR 0·44, 95% CI 0·29-0·67), malignancy (OR 0·43 (95% CI 0·25-0·74), thrombosis (OR 0·51, 95% CI 0·33-0·78) and mental health disorders (OR 0·49, 95% CI 0·30-0·79). The risk of PASC was higher during the pre-Delta variant period but did not vary based on CD4 count, HIV viremia or antiretroviral therapy.
Interpretation: HIV positive status confers a higher risk of PASC. Importantly, COVID-19 vaccination significantly lowered mortality and was protective against PASC among PWH.
Funding Information: This publication was made possible through funding support from the University Hospitals Cleveland Medical Center and the Clinical and Translational Science Collaborative of Cleveland (UL1TR002548) from the National Center for Advancing Translational Sciences (NCATS) component of the NIH and NIH Roadmap for Medical Research.
Declaration of Interests: We declare no competing interests.
Ethics Approval Statement: The study was approved by the Institution Board Review committee at Case Western Reserve University/University Hospitals Cleveland Medical Center. Written informed consent was waived as data from the TriNetX system safeguards patient’s privacy by reporting deidentified data.
Keywords: HIV, SARS-CoV-2, COVID-19, post acute sequelae of SARS-CoV-2, Vaccination
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