80 - COVID-19 Testing, Characteristics, and Outcomes Among People Living with HIV in an Integrated Health System

Background: Understanding attributes of COVID-19 clinical severity among people living with HIV/AIDS (PLWH) is critical for risk stratification and treatment strategies, but data among this population are limited.

Methods: We conducted a retrospective study among health plan members at Kaiser Permanente Southern California. We identified PLWH aged ≥ 18 years with a positive SARS-CoV-2 molecular diagnostic test or COVID-19 diagnosis and compared COVID-19 outcomes to HIV-negative cases. Chart review was conducted to examine HIV viral suppression, most recent CD4+ counts, and antiretroviral regimens in the year prior to COVID-19 diagnosis, as well as COVID-19 clinical presentation and outcomes.

Results: Between 3/1/20 and 5/31/20, 590 PLWH were tested for SARS-CoV-2, of which 47 (8.0%) were positive. An additional 14 patients had a clinical COVID-19 diagnosis, for a total of 61 cases identified among the population of 10,702 PLWH. Of these, 10 (16.4%) were hospitalized, 4 (6.6%) were admitted to ICU, 3 (6.4%) required invasive mechanical ventilation, and 1 (1.6%) died from COVID-19. In comparison, of the 12,921 HIV-negative individuals with COVID-19, 1975 (15.3%) were hospitalized, 494 (3.8%) were admitted to ICU, 444 (3.4%) required invasive mechanical ventilation, and 300 (2.3%) died from COVID-19. For 42 PLWH for whom chart review was complete (cases through 5/7/20), 52% were aged ≥ 50 years, and 98% were male. In the year prior to COVID-19 diagnosis, 98% were virally suppressed (HIV RNA < 40 copies/mL). Most recent mean CD4+ count was 600 cells/mm³, and 4.8% had CD4+ ≤ 200 cells/mm³. Median CD4 count was similar between hospitalized and non-hospitalized patients. Antiretroviral regimens included NRTIs (98% of patients), NNRTIs (31%), PIs (26%), INSTIs (57%), and CCR5 inhibitors (2.3%). The most common presenting symptoms were cough (76% of patients), fever (71%), and shortness of breath (48%).Table 1. SARS-CoV-2 testing, characteristics, and COVID-19 outcomes of HIV-infected and HIV-uninfected individuals at Kaiser Permanente Southern California, 3/1/20 to 5/31/20


Conclusion: In this population of patients with well-controlled HIV, risks of severe COVID-19 outcomes were similar to HIV-negative individuals, although sample sizes of PLWH with COVID-19 were small. Analyses adjusted for demographics and comorbidities are needed to assess risk of severe COVID-19 among PLWH and to determine clinical predictors in this population.

Presenting Author(s)

• 

  Jennifer J. Chang, MD AAHIVS

  HIV/AIDS Primary Care Physician
  Kaiser Permanente at Los Angeles Medical Center
  Los Angeles, CA

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

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Co-Author(s)

• KB

  Katia Bruxvoort, PhD, MPH

  Dr
  Kaiser Permanente Southern California
  Pasadena, California

  Disclosure: GlaxoSmithKlein (Research Grant or Support)
• LC

  Lie Hong Chen, DrPH

  Biostatistician
  Kaiser Permanente Southern California Department of Research and Evaluation
  Pasadena, California

  Disclosure: Merk (Research Grant or Support)
• JR

  Janelle Rodriguez, MD, MS, MPH

  Resident, Family Medicine
  Kaiser Permanente at Los Angeles Medical Center
  Los Angeles, California

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• BA

  Bobak Akhavan, MD

  Fellow, Pulmonary and Critical Care
  Kaiser Permanente at Los Angeles Medical Center
  Los Angeles, California

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• RH

  Rulin C. Hechter, MD, PhD, MS

  Research Scientist
  Kaiser Permanente Southern California Department of Research and Evaluation
  Los Angeles, California

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.