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

Abstract

Background: People with human immunodeficiency virus (HIV) may be at increased risk for long COVID after acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We investigated the association between HIV and long COVID in 2 large electronic health record databases.

Methods: Using data from the Patient-Centered Clinical Research Network (PCORnet) and the National Clinical Cohort Collaborative (N3C) from 1 January 2018 to 30 April 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.

Results: 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 [95% confidence interval {CI}, 1.04-1.14]; N3C: aOR, 1.18 [95% 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 [95% CI, .88-1.16]; N3C: aOR, 1.07 [95% CI, .97-1.18]).

Conclusions: 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 underrecognized in people with HIV and underscore challenges in diagnosing long COVID in populations with baseline chronic conditions.

Keywords: Chronic diseases; HIV; Health disparities; Long COVID; SARS-CoV-2.