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Bender Ignacio RA, Shapiro AE, Nance RM, et al. Racial and ethnic disparities in COVID-19 disease incidence independent of comorbidities, among people with HIV in the US. medRxiv. 2021;doi: 10.1101/2021.12.07.21267296.
Bender Ignacio, R. A., Shapiro, A. E., Nance, R. M., Whitney, B. M., Delaney, J., Bamford, L., Wooten, D., Karris, M., Mathews, W. C., Kim, H. N., Van Rompaey, S. E., Keruly, J. C., Burkholder, G., Napravnik, S., Mayer, K. H., Jacobson, J., Saag, M. S., Moore, R. D., Eron, J. J., Willig, A. L., Christopoulos, K. A., Martin, J., Hunt, P. W., Crane, H. M., Kitahata, M. M., Cachay, E. (2021). Racial and ethnic disparities in COVID-19 disease incidence independent of comorbidities, among people with HIV in the US. medRxiv : the preprint server for health sciences, . https://doi.org/10.1101/2021.12.07.21267296
Bender Ignacio, R A, et al. "Racial and ethnic disparities in COVID-19 disease incidence independent of comorbidities, among people with HIV in the US." medRxiv : the preprint server for health sciences vol. (2021). doi: https://doi.org/10.1101/2021.12.07.21267296
Bender Ignacio RA, Shapiro AE, Nance RM, Whitney BM, Delaney J, Bamford L, Wooten D, Karris M, Mathews WC, Kim HN, Van Rompaey SE, Keruly JC, Burkholder G, Napravnik S, Mayer KH, Jacobson J, Saag MS, Moore RD, Eron JJ, Willig AL, Christopoulos KA, Martin J, Hunt PW, Crane HM, Kitahata MM, Cachay E. Racial and ethnic disparities in COVID-19 disease incidence independent of comorbidities, among people with HIV in the US. medRxiv. 2021 Dec 08; doi: 10.1101/2021.12.07.21267296. PMID: 34909782; PMCID: PMC8669849.
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medRxiv. 2021 Dec 08; doi: 10.1101/2021.12.07.21267296.

Racial and ethnic disparities in COVID-19 disease incidence independent of comorbidities, among people with HIV in the US.

medRxiv : the preprint server for health sciences

R A Bender Ignacio, A E Shapiro, R M Nance, B M Whitney, Jac Delaney, L Bamford, D Wooten, M Karris, W C Mathews, H N Kim, S E Van Rompaey, J C Keruly, G Burkholder, S Napravnik, K H Mayer, J Jacobson, M S Saag, R D Moore, J J Eron, A L Willig, K A Christopoulos, J Martin, P W Hunt, H M Crane, M M Kitahata, E Cachay,

PMID: 34909782 PMCID: PMC8669849 DOI: 10.1101/2021.12.07.21267296

Abstract

OBJECTIVES: To define the incidence of clinically-detected COVID-19 in people with HIV (PWH) in the US and evaluate how racial and ethnic disparities, comorbidities, and HIV-related factors contribute to risk of COVID-19.

DESIGN: Observational study within the CFAR Network of Integrated Clinical Systems cohort in 7 cities during 2020.

METHODS: We calculated cumulative incidence rates of COVID-19 diagnosis among PWH in routine care by key characteristics including race/ethnicity, current and lowest CD4 count, and geographic area. We evaluated risk factors for COVID-19 among PWH using relative risk regression models adjusted with disease risk scores.

RESULTS: Among 16,056 PWH in care, of whom 44.5% were Black, 12.5% were Hispanic, with a median age of 52 years (IQR 40-59), 18% had a current CD4 count < 350, including 7% < 200; 95.5% were on antiretroviral therapy, and 85.6% were virologically suppressed. Overall in 2020, 649 PWH were diagnosed with COVID-19 for a rate of 4.94 cases per 100 person-years. The cumulative incidence of COVID-19 was 2.4-fold and 1.7-fold higher in Hispanic and Black PWH respectively, than non-Hispanic White PWH. In adjusted analyses, factors associated with COVID-19 included female sex, Hispanic or Black identity, lowest historical CD4 count <350 (proxy for CD4 nadir), current low CD4/CD8 ratio, diabetes, and obesity.

CONCLUSIONS: Our results suggest that the presence of structural racial inequities above and beyond medical comorbidities increased the risk of COVID-19 among PWHPWH with immune exhaustion as evidenced by lowest historical CD4 or current low CD4:CD8 ratio had greater risk of COVID-19.

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