HIV Infection and Long COVID: A RECOVER Program, Electronic Health Record Based Cohort Study

Abstract

People with HIV may be at increased risk for long COVID after acute SARS-CoV-2 infection. We investigated the association between HIV and long COVID in two large electronic health record databases. Using data from the Patient-Centered Clinical Research Network (PCORnet) and the National Clinical Cohort Collaborative (N3C) from 1/1/2018 to 4/30/2024, our analytic sample included individuals aged ≥21 years with SARS-CoV-2. All individuals were classified as having HIV or not. We estimated the adjusted odds ratio (aOR) of long COVID by HIV status using logistic regression. Multivariable models controlled for potential associated factors and used 2 cohort definitions: a computed phenotype definition or ICD-10 code-based definition. We included 1,369,896 patients from PCORnet (11,964 with and 1,357,932 without HIV) and 3,312,355 patients from N3C (23,931 with and 3,288,424 without HIV). Using the computed phenotype definition of long COVID, we noted a small, but significant, increase in odds of developing long COVID among people with compared to those without HIV (PCORnet aOR 1.09 [CI 1.04-1.14] and N3C aOR 1.18 [CI 1.13-1.23]). Using the ICD-10 definition of long COVID, there was no association between HIV and long-COVID (PCORnet aOR 1.01 [CI 0.88-1.16] and N3C aOR 1.07 [CI 0.97-1.18], respectively). In this large multicenter study, people with HIV had a modestly increased risk of long COVID when defined by a computed phenotype, but not when using ICD-10 codes. These findings suggest that long COVID may be under-recognized in people with HIV and underscore challenges in diagnosing long COVID in populations with baseline chronic conditions.

Keywords: HIV; Long COVID; SARS-CoV-2.