Elevated Risk of COVID-19 Infection among People Living with HIV in Mumbai

Abstract

Introduction:

According to Joint United Nations Program on HIV/AIDS 2021, people living with HIV (PLHIV) have higher comorbidities and experience more severe outcomes from COVID-19 as compared to non-PLHIV. Studies from India reporting on the risk of COVID-19 acquisition among PLHIV are lacking. In this study, we attempted to estimate the risk of COVID-19 infection among PLHIV at our high throughput COVID-19 testing facility in Mumbai, India.

Methods:

A retrospective observational study was undertaken of suspected COVID-19 cases between April and December 2020. The unadjusted and adjusted odds ratios with 95% confidence interval for the risk factors were calculated by logistic regression using the SPSS software (version 19).

Results:

A total of 58,811 naso/oropharyngeal swabs in viral transport medium samples were tested for the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcriptase polymerase chain reaction from April 22, 2020 to December 31, 2020. Out of these, 18,508 (31.4%) samples were found positive for SARS-CoV-2 infection. Of the total samples tested, 65 (0.11%) individuals had reported history of HIV as an underlying medical condition. Out of the total COVID-19 positive patients, 52 (0.28%) had HIV infection.

Conclusion:

Our study highlights an increased susceptibility of PLHIV to COVID-19 infection, which necessitates active monitoring undertaken of this population for optimal disease management.

Introduction

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in India has considerably reduced, and vaccination coverage has significantly progressed to ∼980 million doses administered.1 India bears among the largest burden of COVID-19 cases as well as population of people living with HIV (PLHIV) globally.2,3 Being immunocompromised, PLHIV potentially remain at risk for acquisition and severe disease course of COVID-19.4 Epidemiological reporting on this population in India as well as other lower middle income countries is scanty5 –7 and limited to isolated case reports.8 In this study, we report on proportion and risk of COVID-19 among PLHIV at a high throughput national COVID-19 testing center in Mumbai.

Methodology

A retrospective observational study was undertaken of suspected COVID-19 cases received by our laboratory during the period from April to December 2020. This study received approval from ICMR-NIRRCH Ethics Committee (Project Number: 452/2021). A sample was defined as COVID-19 positive when a naso/oropharyngeal swab tested positive for SARS-CoV-2 by reverse transcriptase polymerase chain reaction (RT-PCR) assay. The percentage distribution of COVID-19 cases is presented in Table1. The unadjusted and adjusted odds ratios with 95% confidence interval for the risk factors (age, gender, comorbidity, HIV, and symptomatic status) were calculated by using the multivariable logistic regression model considering COVID-19 status as dependent variables. All the analysis was performed using the SPSS software (version 19).

Results and Discussion

A total of 58,811 naso/oropharyngeal swabs in viral transport medium samples were tested for the presence of SARS-CoV-2 by RT-PCR from April 22, 2020 to December 31, 2020. Out of these, 18,508 (31.4%) samples were found positive for SARS-CoV-2. Of the total samples tested, 65 (0.11%) individuals had reported history of HIV as an underlying medical condition. Out of the total COVID-19 positive patients, 52 (0.28%) had HIV infection. The demographic and clinical characteristics of PLHIV with COVID-19 and non-PLHIV with COVID-19 together with temporal distribution of cases are described in Supplementary Table 1 and Figure 1, respectively.

Overall, COVID-19 was found to be significantly more prevalent in males as compared to females (Table1), a trend which was also observed in PLHIV (Supplementary Table 1). As expected, comorbidities and symptomatic status were significant risk factors for COVID-19 in our study population (Table1). Furthermore, stratification by age suggested an elevated risk for COVID-19 in the age group above 55 years. When HIV status was considered either in isolation (unadjusted odds ratio) or in conjunction with other factors listed in Table1 (adjusted odds ratio), it proved to be a significant contributory risk factor for COVID-19. These results indicate an increased vulnerability of PLHIV to COVID-19 infection in India and highlight the need for greater epidemiological surveillance of this population to enable the implementation of optimal disease management strategies.

Table1.

Demographic distribution, and unadjusted and adjusted odds ratios of COVID-19 cases

Variables	COVID-19 status				Unadjusted odds ratio (95% CI)	Adjusted odds ratio (95% CI)
	Negative		Positive
	n	%	n	%
Age (years)
<18	3,043	7.6	1,282	6.9	0.37 (0.34–0.40)	0.56 (0.51–0.60)
18–55	33,454	83.0	12,887	69.6	0.34 (0.32–0.35)	0.47 (0.44–0.49)
55+	3,806	9.4	4,339	23.4	1.00	1.00
Gender
Female	17,799	44.2	7,199	38.9	1.00	1.00
Male	22,504	55.8	11,309	61.1	1.24 (1.20–1.29)	1.19 (1.15–1.24)
Comorbidity
No	39,126	97.1	16,212	87.6	1.00	1.00
Yes	1,177	2.9	2,296	12.4	4.71 (4.38–5.06)	1.97 (1.82–2.14)
Symptomatic
No	33,757	83.8	10,847	58.6	1.00	1.00
Yes	6,546	16.2	7,661	41.4	3.64 (3.50–3.79)	2.94 (2.81–3.06)
HIV status
No	40,290	100.0	18,456	99.7	1.00	1.00
Yes	13.0	0.0	52.0	0.3	8.73 (4.75–16.04)	2.24 (1.18–4.24)

Author’s Contribution Statement: KJ, PS, DJ, and VP conceptualized the study, conducted the primary data analysis, and wrote the manuscript. SB contributed to statistical analysis. SB, RG, SK, CA, VB, DG, KS, NM, KM, SP, GS, SM, VMB, DJ, and VP contributed to the revision of the manuscript for important intellectual content and study supervision. All authors discussed the results and contributed to the final manuscript.

Conflict of Interest: The authors declare that they have no competing interests.

Funding Statement: This work was supported by the Indian Council of Medical Research-National Institute for Research in Reproductive and Child Health (ICMR-NIRRCH). The funding body had no role in the design of the study; collection, analysis, and interpretation of data; or in writing the manuscript.

Footnotes

Acknowledgments

We are grateful to Director General, Indian Council of Medical Research (ICMR), Ministry for Health & Family Welfare, Government of India, for encouraging and supporting with resources, the pursuit of important research questions relevant to COVID-19 pathogenesis.

References

Ministry of Electronics & Information Technology. GoI. #IndiaFightsCorona COVID-19. Available at https://www.mygov.in/covid-19/. Accessed October 18, 2021.

Johns Hopkins University of Medicine. COVID-19 dashboard. Available at https://coronavirus.jhu.edu/map.html. Accessed October 18, 2021.

National AIDS Control Organization, MoHFW. HIV facts & figures. Available at http://naco.gov.in/hiv-facts-figures. Accessed October 18, 2021.

CDC; National Center for Immunization and Respiratory Diseases (NCIRD)-Division of Viral Diseases. People with certain medical conditions. Available at https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Accessed October 18, 2021.

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Supplementary Material

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Elevated Risk of COVID-19 Infection among People Living with HIV in Mumbai—A Retrospective Study