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

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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]

 

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Full paper now published:

HIV Infection and Long COVID: A RECOVER Program, Electronic Health Record Based Cohort Study

Kellie L Hawkins, Dima Dandachi, Zoe Verzani, M Daniel Brannock, Colby Lewis, Sajjad Abedian, Sohrab Jaferian, Shannon Wuller, Jennifer Truong, Margot Gage Witvliet, Gretchen Dymond, Hemalkumar B Mehta, Payal B Patel, Elaine Hill, Mark G Weiner, Thomas W Carton, Rainu Kaushal, Elen Feuerriegel, Huong G Tran, Kristen Marks, Carlos R Oliveira, Edward M Gardner, Igho Ofotokun, Roy M Gulick, Kristine M Erlandson on behalf of, the RECOVER Consortium, the N3C Consortium, the PCORnet Consortium

Abstract
People with HIV may be at increased risk for long COVID after acute SARS-CoV-2 infection. We investigated the association between HIV and long COVID in two large electronic health record databases.

Using data from the Patient-Centered Clinical Research Network (PCORnet) and the National Clinical Cohort Collaborative (N3C) from 1/1/2018 to 4/30/2024, our analytic sample included individuals aged ≥21 years with SARS-CoV-2. All individuals were classified as having HIV or not. We estimated the adjusted odds ratio (aOR) of long COVID by HIV status using logistic regression. Multivariable models controlled for potential associated factors and used 2 cohort definitions: a computed phenotype definition or ICD-10 code-based definition.

We included 1,369,896 patients from PCORnet (11,964 with and 1,357,932 without HIV) and 3,312,355 patients from N3C (23,931 with and 3,288,424 without HIV). Using the computed phenotype definition of long COVID, we noted a small, but significant, increase in odds of developing long COVID among people with compared to those without HIV (PCORnet aOR 1.09 [CI 1.04-1.14] and N3C aOR 1.18 [CI 1.13-1.23]). Using the ICD-10 definition of long COVID, there was no association between HIV and long-COVID (PCORnet aOR 1.01 [CI 0.88-1.16] and N3C aOR 1.07 [CI 0.97-1.18], respectively).

In this large multicenter study, people with HIV had a modestly increased risk of long COVID when defined by a computed phenotype, but not when using ICD-10 codes. These findings suggest that long COVID may be under-recognized in people with HIV and underscore challenges in diagnosing long COVID in populations with baseline chronic conditions.

Link (Clinical Infectious Diseases) [Paywall]