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HIV infection and COVID-19 death: a population-based cohort analysis of UK primary care data and linked national death registrations within the OpenSAFELY platform.
Lancet HIV. 2021 01; 8(1):e24-e32.LH

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.

Authors+Show Affiliations

Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK. Electronic address: krishnan.bhaskaran@lshtm.ac.uk.Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.The Phoenix Partnership, TPP House, Horsforth, Leeds, UK.The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.The Phoenix Partnership, TPP House, Horsforth, Leeds, UK.Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.The Phoenix Partnership, TPP House, Horsforth, Leeds, UK.The Phoenix Partnership, TPP House, Horsforth, Leeds, UK.The Phoenix Partnership, TPP House, Horsforth, Leeds, UK.Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33316211

Citation

Bhaskaran, Krishnan, et al. "HIV Infection and COVID-19 Death: a Population-based Cohort Analysis of UK Primary Care Data and Linked National Death Registrations Within the OpenSAFELY Platform." The Lancet. HIV, vol. 8, no. 1, 2021, pp. e24-e32.
Bhaskaran K, Rentsch CT, MacKenna B, et al. HIV infection and COVID-19 death: a population-based cohort analysis of UK primary care data and linked national death registrations within the OpenSAFELY platform. Lancet HIV. 2021;8(1):e24-e32.
Bhaskaran, K., Rentsch, C. T., MacKenna, B., Schultze, A., Mehrkar, A., Bates, C. J., Eggo, R. M., Morton, C. E., Bacon, S. C. J., Inglesby, P., Douglas, I. J., Walker, A. J., McDonald, H. I., Cockburn, J., Williamson, E. J., Evans, D., Forbes, H. J., Curtis, H. J., Hulme, W. J., ... Goldacre, B. (2021). HIV infection and COVID-19 death: a population-based cohort analysis of UK primary care data and linked national death registrations within the OpenSAFELY platform. The Lancet. HIV, 8(1), e24-e32. https://doi.org/10.1016/S2352-3018(20)30305-2
Bhaskaran K, et al. HIV Infection and COVID-19 Death: a Population-based Cohort Analysis of UK Primary Care Data and Linked National Death Registrations Within the OpenSAFELY Platform. Lancet HIV. 2021;8(1):e24-e32. PubMed PMID: 33316211.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - HIV infection and COVID-19 death: a population-based cohort analysis of UK primary care data and linked national death registrations within the OpenSAFELY platform. AU - Bhaskaran,Krishnan, AU - Rentsch,Christopher T, AU - MacKenna,Brian, AU - Schultze,Anna, AU - Mehrkar,Amir, AU - Bates,Chris J, AU - Eggo,Rosalind M, AU - Morton,Caroline E, AU - Bacon,Sebastian C J, AU - Inglesby,Peter, AU - Douglas,Ian J, AU - Walker,Alex J, AU - McDonald,Helen I, AU - Cockburn,Jonathan, AU - Williamson,Elizabeth J, AU - Evans,David, AU - Forbes,Harriet J, AU - Curtis,Helen J, AU - Hulme,William J, AU - Parry,John, AU - Hester,Frank, AU - Harper,Sam, AU - Evans,Stephen J W, AU - Smeeth,Liam, AU - Goldacre,Ben, Y1 - 2020/12/11/ PY - 2020/08/07/received PY - 2020/10/23/revised PY - 2020/11/03/accepted PY - 2020/12/15/pubmed PY - 2021/1/13/medline PY - 2020/12/14/entrez SP - e24 EP - e32 JF - The lancet. HIV JO - Lancet HIV VL - 8 IS - 1 N2 - 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. SN - 2352-3018 UR - https://www.unboundmedicine.com/medline/citation/33316211/HIV_infection_and_COVID_19_death:_a_population_based_cohort_analysis_of_UK_primary_care_data_and_linked_national_death_registrations_within_the_OpenSAFELY_platform_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2352-3018(20)30305-2 DB - PRIME DP - Unbound Medicine ER -