Abstract
Background: Whether HIV infection is associated with risk of death due to COVID-19 is unclear. We aimed to investigate this association in a large-scale population-based study in England. Methods: We did a retrospective cohort study. Working on behalf of NHS England, we used the OpenSAFELY platform to analyse routinely collected electronic primary care data linked to national death registrations. We included all adults (aged ≥18 years) alive and in follow-up on Feb 1, 2020, and with at least 1 year of continuous registration with a general practitioner before this date. People with a primary care record for HIV infection were compared with people without HIV. The outcome was COVID-19 death, defined as the presence of International Classification of Diseases 10 codes U07.1 or U07.2 anywhere on the death certificate. Cox regression models were used to estimate the association between HIV infection and COVID-19 death; they were initially adjusted for age and sex, then we added adjustment for index of multiple deprivation and ethnicity, and then for a broad range of comorbidities. Interaction terms were added to assess effect modification by age, sex, ethnicity, comorbidities, and calendar time. Results: 17 282 905 adults were included, of whom 27 480 (0·16%) had HIV recorded. People living with HIV were more likely to be male, of Black ethnicity, and from a more deprived geographical area than the general population. 14 882 COVID-19 deaths occurred during the study period, with 25 among people with HIV. People living with HIV had higher risk of COVID-19 death than those without HIV after adjusting for age and sex: hazard ratio (HR) 2·90 (95% CI 1·96–4·30; p<0·0001). The association was attenuated, but risk remained high, after adjustment for deprivation, ethnicity, smoking and obesity: adjusted HR 2·59 (95% CI 1·74–3·84; p<0·0001). There was some evidence that the association was larger among people of Black ethnicity: HR 4·31 (95% CI 2·42–7·65) versus 1·84 (1·03–3·26) in non-Black individuals (p-interaction=0·044). Interpretation: People with HIV in the UK seem to be at increased risk of COVID-19 mortality. Targeted policies should be considered to address this raised risk as the pandemic response evolves. Funding: Wellcome, Royal Society, National Institute for Health Research, National Institute for Health Research Oxford Biomedical Research Centre, UK Medical Research Council, Health Data Research UK.
| Original language | English |
|---|---|
| Pages (from-to) | e24-e32 |
| Journal | The Lancet HIV |
| Volume | 8 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 11 Dec 2020 |
| Externally published | Yes |
Bibliographical note
Funding Information:No dedicated funding has yet been obtained for this work. TPP provided technical expertise and infrastructure within their data centre pro bono in the context of a national emergency. KB holds a Sir Henry Dale fellowship jointly funded by Wellcome and the Royal Society (107731/Z/15/Z). AS is employed by the London School of Hygiene & Tropical Medicine on a fellowship sponsored by GlaxoSmithKline. AM is funded by NHS Digital. IJD holds grants from the National Institute of Health Research (NIHR) and GlaxoSmithKline. HIM is funded by the NIHR Health Protection Research Unit in Immunisation, a partnership between Public Health England and London School of Hygiene & Tropical Medicine. EJW holds grants from the Medical Research Council (MRC). HF holds a UK Research and Innovation (UKRI) fellowship. RME is funded by Health Data Research UK (MR/S003975/1) and MRC (MC_PC 19065). LS reports grants from Wellcome, MRC, NIHR, UKRI, British Council, GlaxoSmithKline, British Heart Foundation, and Diabetes UK outside this work. BG's work on better use of data in health care more broadly is funded in part by NIHR Oxford Biomedical Research Centre, NIHR Applied Research Collaboration Oxford and Thames Valley, the Mohn-Westlake Foundation, NHS England, and the Health Foundation; all DataLab staff are supported by BG's grants on this work. The views expressed are those of the authors and not necessarily those of the NIHR, NHS England, Public Health England or the Department of Health and Social Care. Funders had no role in the study design, collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
Funding Information:
No dedicated funding has yet been obtained for this work. TPP provided technical expertise and infrastructure within their data centre pro bono in the context of a national emergency. KB holds a Sir Henry Dale fellowship jointly funded by Wellcome and the Royal Society (107731/Z/15/Z). AS is employed by the London School of Hygiene & Tropical Medicine on a fellowship sponsored by GlaxoSmithKline. AM is funded by NHS Digital. IJD holds grants from the National Institute of Health Research (NIHR) and GlaxoSmithKline. HIM is funded by the NIHR Health Protection Research Unit in Immunisation, a partnership between Public Health England and London School of Hygiene & Tropical Medicine. EJW holds grants from the Medical Research Council (MRC). HF holds a UK Research and Innovation (UKRI) fellowship. RME is funded by Health Data Research UK (MR/S003975/1) and MRC (MC_PC 19065). LS reports grants from Wellcome, MRC, NIHR, UKRI, British Council, GlaxoSmithKline, British Heart Foundation, and Diabetes UK outside this work. BG's work on better use of data in health care more broadly is funded in part by NIHR Oxford Biomedical Research Centre, NIHR Applied Research Collaboration Oxford and Thames Valley, the Mohn-Westlake Foundation, NHS England, and the Health Foundation; all DataLab staff are supported by BG's grants on this work.
Publisher Copyright:
© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
ASJC Scopus subject areas
- Epidemiology
- Immunology
- Infectious Diseases
- Virology
