Risk of COVID-19 hospitalisation by HIV-status and SARS-CoV-2 vaccination status during pre- and post-Omicron era in a national register-based cohort study in Sweden
(2024) In Infectious Diseases- Abstract
Background: Data on the outcomes of COVID-19 in people living with HIV (PLHIV), specifically in relation to vaccination status, are lacking during the Omicron era. Methods: This nationwide registry-based study included all resident in Sweden ≥18 years with a positive SARS-CoV-2 PCR test during January 2021–February 2023. We estimated adjusted odds ratios (adjOR) for COVID-19 hospitalisation and severe COVID-19 (ICU admission and 90-day mortality), categorised by SARS-CoV-2 vaccination status (0–1, 2, and ≥3 doses), and HIV-status. Analyses were then categorised by time periods of pre-Omicron, Omicron during public testing, and Omicron after public testing. Results: 1348 PLHIV and 1 669 389 people without HIV (PWoH) were included. PLHIV... (More)
Background: Data on the outcomes of COVID-19 in people living with HIV (PLHIV), specifically in relation to vaccination status, are lacking during the Omicron era. Methods: This nationwide registry-based study included all resident in Sweden ≥18 years with a positive SARS-CoV-2 PCR test during January 2021–February 2023. We estimated adjusted odds ratios (adjOR) for COVID-19 hospitalisation and severe COVID-19 (ICU admission and 90-day mortality), categorised by SARS-CoV-2 vaccination status (0–1, 2, and ≥3 doses), and HIV-status. Analyses were then categorised by time periods of pre-Omicron, Omicron during public testing, and Omicron after public testing. Results: 1348 PLHIV and 1 669 389 people without HIV (PWoH) were included. PLHIV were older, more migrant (65 vs. 22%) and male (59 vs. 46%). Of PLHIV, 96% were on antiretroviral treatment and 94% virally suppressed. AdjORs of COVID-19 hospitalisation were similar irrespective of HIV-status, controlled for demographics, calendar month of infection, comorbidities, and income. PLHIV were more likely to be hospitalised than PWoH during Omicron and public testing (adjOR 2.3, 95% CI 1.1–4.2), but not after public testing. The odds of severe COVID-19 were three times higher in PLHIV compared to PWoH vaccinated with 2 doses (adjOR 3.2, 95% CI 1.3–6.9), but not when vaccinated with ≥3 doses (adjOR 0.7, 95% CI 0.2–1.6). Migrant and low nadir CD4+ T-cells were associated with higher odds of hospitalisation in unvaccinated PLHIV. Conclusions: This nationwide study, including mostly well-treated PLHIV, highlights the importance of vaccination with booster dose/s for effective protection against severe COVID-19 in PLHIV.KEY POINT People living with HIV compared to people without HIV did not have higher odds of COVID-19 hospitalisation irrespective of SARS-CoV-2 vaccination status (0–1 dose, 2 doses, ≥3 doses) when adjusting for known risk factors including comorbidities and socioeconomic status.
(Less)
- author
- organization
- publishing date
- 2024
- type
- Contribution to journal
- publication status
- epub
- subject
- keywords
- COVID-19, COVID-19 vaccines, HIV, SARS-CoV-2
- in
- Infectious Diseases
- publisher
- Taylor & Francis
- external identifiers
-
- scopus:85204783482
- pmid:39320271
- ISSN
- 2374-4235
- DOI
- 10.1080/23744235.2024.2405582
- language
- English
- LU publication?
- yes
- id
- 9dc6c938-7f69-4725-a1a6-1df51e92aad1
- date added to LUP
- 2024-11-27 11:49:49
- date last changed
- 2025-05-29 02:50:31
@article{9dc6c938-7f69-4725-a1a6-1df51e92aad1,
abstract = {{<p>Background: Data on the outcomes of COVID-19 in people living with HIV (PLHIV), specifically in relation to vaccination status, are lacking during the Omicron era. Methods: This nationwide registry-based study included all resident in Sweden ≥18 years with a positive SARS-CoV-2 PCR test during January 2021–February 2023. We estimated adjusted odds ratios (adjOR) for COVID-19 hospitalisation and severe COVID-19 (ICU admission and 90-day mortality), categorised by SARS-CoV-2 vaccination status (0–1, 2, and ≥3 doses), and HIV-status. Analyses were then categorised by time periods of pre-Omicron, Omicron during public testing, and Omicron after public testing. Results: 1348 PLHIV and 1 669 389 people without HIV (PWoH) were included. PLHIV were older, more migrant (65 vs. 22%) and male (59 vs. 46%). Of PLHIV, 96% were on antiretroviral treatment and 94% virally suppressed. AdjORs of COVID-19 hospitalisation were similar irrespective of HIV-status, controlled for demographics, calendar month of infection, comorbidities, and income. PLHIV were more likely to be hospitalised than PWoH during Omicron and public testing (adjOR 2.3, 95% CI 1.1–4.2), but not after public testing. The odds of severe COVID-19 were three times higher in PLHIV compared to PWoH vaccinated with 2 doses (adjOR 3.2, 95% CI 1.3–6.9), but not when vaccinated with ≥3 doses (adjOR 0.7, 95% CI 0.2–1.6). Migrant and low nadir CD4<sup>+</sup> T-cells were associated with higher odds of hospitalisation in unvaccinated PLHIV. Conclusions: This nationwide study, including mostly well-treated PLHIV, highlights the importance of vaccination with booster dose/s for effective protection against severe COVID-19 in PLHIV.KEY POINT People living with HIV compared to people without HIV did not have higher odds of COVID-19 hospitalisation irrespective of SARS-CoV-2 vaccination status (0–1 dose, 2 doses, ≥3 doses) when adjusting for known risk factors including comorbidities and socioeconomic status.</p>}},
author = {{Killander Möller, Isabela and Hedberg, Pontus and Wagner, Philippe and Lindahl, Hannes and Nyström, Sofia and Blixt, Lisa and Eketorp Sylvan, Sandra and Nilsdotter-Augustinsson, Åsa and Österborg, Anders and Fredrikson, Mats and Hansson, Lotta and Kahn, Fredrik and Sparén, Pär and Gisslén, Magnus and Nauclér, Pontus and Bergman, Peter and Aleman, Soo and Carlander, Christina}},
issn = {{2374-4235}},
keywords = {{COVID-19; COVID-19 vaccines; HIV; SARS-CoV-2}},
language = {{eng}},
publisher = {{Taylor & Francis}},
series = {{Infectious Diseases}},
title = {{Risk of COVID-19 hospitalisation by HIV-status and SARS-CoV-2 vaccination status during pre- and post-Omicron era in a national register-based cohort study in Sweden}},
url = {{http://dx.doi.org/10.1080/23744235.2024.2405582}},
doi = {{10.1080/23744235.2024.2405582}},
year = {{2024}},
}