918 – HIV Infection and Long COVID: A RECOVER Program, EHR-Based Cohort Study, 2025, Hawkins et al

918 – HIV Infection and Long COVID: A RECOVER Program, EHR-Based Cohort Study

Kellie L. Hawkins, Dima Dandachi, Colby Lewis, M. Daniel Brannock, Zoe Verzani, Saajjad Abedian, Sohrab Jaferian, Shannon Wuller, Jennifer Truong, Margot Gage Witvliet, Kristen Marks, Edward M. Gardner, Ighovwerha Ofotokun, Roy M. Gulick, Kristine M. Erlandson

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Background
Studies show that people with HIV (PWH) may be prone to post-acute sequela of SARS-CoV-2 infection (PASC), or Long COVID (LC). We investigated the association between HIV status and LC utilizing the National Patient-Centered Clinical Research Network (PCORnet) and the NCATS National COVID Cohort Collaborative (N3C) databases.

Methods
PCORnet and N3C cohorts were queried from 1/1/2018 to 4/30/2024, limited to age ≥21 with COVID (ICD10 diagnosis codes, positive test, use of nirmatrelvir/ritonavir), and stratified by HIV status and sex at birth. Covariates included age, race, COVID severity (hospitalization), variant, pre-pandemic health utilization, and Charlson Comorbidity Index (CCI) score.

Uni/multivariable models compared LC development after COVID diagnosis by HIV status. Odds ratios (OR) of LC defined based on the ICD10 code or computable phenotype (CP, symptoms post COVID) in relation to HIV status for each cohort are presented. CP was distinct in PCORnet and N3C.

Results
PCORnet included 11,964 with and 1,357,932 without HIV and N3C 23,931 with and 3,288,424 without HIV. In both cohorts, PWH were more likely to be male, identify as Hispanic or Black, have higher CCI score (irrespective of HIV), and higher pre-pandemic healthcare utilization compared to people without HIV.

There were more patients in both cohorts assigned long COVID using the computable phenotype than ICD10 code (19 vs. 1.7% in PCORnet and 8.1 vs. 1.4% in N3C).

By computable phenotype, a small increased odds of developing long COVID was seen among people with compared to without HIV in both cohorts (PCORnet adjusted OR 1.09 [CI 1.04-1.14] and N3C adjusted OR 1.18 [CI 1.13-1.23]).

By ICD10, there was no association between long COVID and HIV in either cohort (adjusted OR 1.01 [CI 0.88-1.16] and 1.07 [CI 0.97-1.18]), respectively.

Conclusions
Data from two large cohorts support an increased risk of long COVID development in people with HIV, and highlights challenges and possible disparities in recognizing and diagnosing long COVID.

Link (Conference on Retroviruses and Opportunistic Infections) [Abstract Only]