Racial and ethnic disparities in coronavirus disease 2019 disease incidence independent of comorbidities, among people with HIV in the United States
Year: 2022
Type: article
Study design: Observational Study
Abstract: OBJECTIVES: To define the incidence of clinically-detected COVID-19 in people with HIV (PWH) in the US and evaluate how racial and ethnic disparities, comorbidities, and HIV-related factors contribute to risk of COVID-19. DESIGN: Observational study within the CFAR Network of Integrated Clinical Systems cohort in 7 cities during 2020. METHODS: We calculated cumulative incidence rates of COVID-19 diagnosis among PWH in routine care by key characteristics including race/ethnicity, current and lowest CD4 count, and geographic area. We evaluated risk factors for COVID-19 among PWH using relative risk regression models adjusted with disease risk scores. RESULTS: Among 16,056 PWH in care, of whom 44.5% were Black, 12.5% were Hispanic, with a median age of 52 years (IQR 40-59), 18% had a current CD4 count < 350, including 7% < 200; 95.5% were on antiretroviral therapy, and 85.6% were virologically suppressed. Overall in 2020, 649 PWH were diagnosed with COVID-19 for a rate of 4.94 cases per 100 person-years. The cumulative incidence of COVID-19 was 2.4-fold and 1.7-fold higher in Hispanic and Black PWH respectively, than non-Hispanic White PWH. In adjusted analyses, factors associated with COVID-19 included female sex, Hispanic or Black identity, lowest historical CD4 count <350 (proxy for CD4 nadir), current low CD4/CD8 ratio, diabetes, and obesity. CONCLUSIONS: Our results suggest that the presence of structural racial inequities above and beyond medical comorbidities increased the risk of COVID-19 among PWHPWH with immune exhaustion as evidenced by lowest historical CD4 or current low CD4:CD8 ratio had greater risk of COVID-19.
Source: AIDS
Authors: RA Bender Ignacio, AE Shapiro, RM Nance, BM Whitney, JAC Delaney, L Bamford, D Wooten, M Karris, WC Mathews, HN Kim, SE Van Rompaey, JC Keruly, G Burkholder, S Napravnik, KH Mayer, J Jacobson, MS Saag, RD Moore, JJ Eron, AL Willig, KA Christopoulos, J Martin, PW Hunt, HM Crane, MM Kitahata, E Cachay
Institutions: University of Washington, Fred Hutch Cancer Center, University of Manitoba, University of California San Diego, Johns Hopkins University, Johns Hopkins Medicine, University of Alabama at Birmingham, University of North Carolina at Chapel Hill, Harvard University, Fenway Health, Case Western Reserve University, University of California, San Francisco
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Funders: Gilead Sciences, Case Western Reserve University, Seagen, National Institutes of Health, University of California, San Diego, University of California, San Francisco, Center for AIDS Research, Johns Hopkins University, Center for AIDS Research, University of Alabama at Birmingham, National Institute on Drug Abuse, National Institute of Allergy and Infectious Diseases, National Center for Advancing Translational Sciences, Center for AIDS Research, University of North Carolina at Chapel Hill
Awards: G1077701788, G1090173496, G1467100060, G1531094742, G1636177350, G1939027404, G2122320390, G2127051194, G2184348974, G2219438539, G2328354421, G2608369044, G2898952431, G2928778974, G312098406, G3181090803, G3407947818, G342295615, G378552126, G3789320706, G3917235369, G4166928756, G4610217253, G495691247, G5316515788, G5699974340, G6333266910, G653582874, G654751394, G7693982760, G7871313406, UC San Diego Clinical and Translational Research Institute, San Diego Center for AIDS Research (SD CFAR), Rustbelt Center for AIDS Research (Case/UHC-Pitt CFAR), The Johns Hopkins Center for AIDS Research (JHU CFAR), CFAR Network of Integrated Clinical Systems (CNICS), The University of North Carolina Center for AIDS Research, UAB Center for AIDS Research (CFAR), G90079629, G929137571, G97119092
OpenAlex ID: W4283656033