Background:
People with HIV (PWH) are at a higher risk of severe acute COVID-19; however, their risk of subsequently developing post-acute sequelae of SARS-CoV2 (PASC) remains unclear. Furthermore, although vaccination has been shown to be protective against PASC in the general population, few studies have evaluated its effectiveness in PWH.
Methods:
We used the TriNetX health research database to source data from 69 healthcare organizations within the US. We included any adults aged ≥ 18 years with positive SARS-CoV-2 between January 1, 2020 and September 16, 2022 and categorized them based on their HIV status, baseline sociodemographic characteristics, comorbidities and COVID-19 vaccination status. The primary outcome was risk of PASC, compared by HIV and vaccination status after 1:1 propensity score matching. PASC was defined as either the persistence of COVID-attributable symptoms or the occurrence of new-onset health conditions at least 28 days following COVID-19 diagnosis. For all analysis, statistical significance was set at p < 0.05.
Results:
Of 3,048,792 people with confirmed SARS-CoV-2 infection, 1% (n=28,904) were PWH, with 9% of PWH (n=2592) vaccinated. At 28 days post-COVID-19 diagnosis, PWH had lower mortality compared with their non-HIV counterparts (OR 0.78, 95% CI 0.70-0.87), but higher risk of developing new-onset diabetes (DM) (OR 1·26, 95% CI 1·11-1·42), heart disease (OR 1·27, 95% 1·14-1·41), malignancy (OR 1·66, 95% CI 1·45-1·89), thrombosis (OR 1·25, 95% CI 1·12-1·39) and mental health disorders (OR 1·70 (95% CI 1·53-1·90). Furthermore, vaccinated PWH had significantly lower odds of death (OR 0·63, 95% CI 0·42-0·93) and each new-onset PASC outcome, as follows: DM (OR 0·51, 95% CI 0·32-0·82), heart disease (OR 0·44, 95% CI 0·29-0·67), malignancy (OR 0·43 (95% CI 0·25-0·74), thrombosis (OR 0·51, 95% CI 0·33-0·78) and mental health disorders (OR 0·49, 95% CI 0·30-0·79). The risk of PASC was higher during the pre-Delta variant period but did not vary based on CD4 count or HIV viremia.
Conclusions:
HIV infection confers a higher risk of PASC. Importantly, COVID-19 vaccination significantly lowered mortality and was protective against PASC among PWH. With the increase in the number of COVID-19 survivors, vaccination offers an effective preventive strategy to address a burgeoning public health problem.
PASC outcomes and effect of vaccination on PASC among HIV+ after propensity score matching