Impact of HIV on COVID-19 Outcomes: A Propensity Score Matching Analysis with Varying Age Differences

Abstract

To exploratorily test (1) the impact of HIV and aging process among PLWH on COVID-19 outcomes; and (2) whether the effects of HIV on COVID-19 outcomes differed by immunity level. The data used in this study was retrieved from the COVID-19 positive cohort in National COVID Cohort Collaborative (N3C). Multivariable logistic regression models were conducted on populations that were matched using either exact matching or propensity score matching (PSM) with varying age difference between PLWH and non-PLWH to examine the impact of HIV and aging process on all-cause mortality and hospitalization among COVID-19 patients. Subgroup analyses by CD4 counts and viral load (VL) levels were conducted using similar approaches. Among the 2,422,864 adults with a COVID-19 diagnosis, 15,188 were PLWH. PLWH had a significantly higher odds of death compared to non-PLWH until age difference reached 6 years or more, while PLWH were still at an elevated risk of hospitalization across all matched cohorts. The odds of both severe outcomes were persistently higher among PLWH with CD4 < 200 cells/mm³. VL ≥ 200 copies/ml was only associated with higher hospitalization, regardless of the predefined age differences. Age advancement in HIV might significantly contribute to the higher risk of COVID-19 mortality and HIV infection may still impact COVID-19 hospitalization independent of the age advancement in HIV.

Keywords: Aging process; COVID-19 outcomes; People living with HIV; Propensity score matching.

Fig. 1

Study participants selection. *Per National COVID Cohort Collaborative Policy, we concealed the numbers of patients in each category because some categories included less than 20 individuals

Fig. 2

OR of mortality using 1:1 PSM data with age differences

Fig. 3

OR of hospitalization using 1:1 PSM data with age differences. Note The dots are estimated OR of specific outcome. The valid and dashed curves are OR and 95% CI along with the changing of age difference

Fig. 4

OR of different COVID-19 outcomes using 1:1 PSM data for PLWH with CD4 < 200 cells/mm³

Fig. 5

OR of different COVID-19 outcomes using 1:1 PSM data for PLWH with CD4 ≥ 200 cells/mm³. Note The dots are estimated OR of specific outcome. The valid and dashed curves are OR and 95% CI along with the changing of age difference