The role of HIV infection in the clinical spectrum of COVID-19: a population-based cohort analysis based on US National COVID Cohort Collaborative (N3C) Enclave data

Background Evidence of whether people living with HIV (PLWH) are at elevated risk of adverse COVID-19 outcomes is limited. We aimed to investigate this association using the population-based National COVID Cohort Collaborative (N3C) data in the US. Methods The harmonized, high-granularity electronic health record data from 54 clinical sites in N3C were used for this study. Logistic and multinomial logistic regression models were employed to estimate the association between HIV infection and hospitalization, mortality, and clinical severity of COVID-19, with models being initially adjusted for age and sex, then cumulatively adjusted for race and ethnicity, smoking and obesity, and a broad range of comorbidities. Interaction terms were added to assess the modification effect by age, sex, and race. Findings Among a total of 1,436,622 adult COVID-19 cases between January 2020 and May 2021, 13,170 had HIV infection. A total of 26,130 deaths occurred, with 445 among PLWH. PLWH had a higher risk of COVID-19 death and hospitalization than non-PLWH after adjusting for age and sex. The associations were attenuated, but remained significant, after adjusting for lifestyle factors and comorbidities (COVID-19 death: [adjusted OR(AOR): 1.38; 95%CI: 1.25-1.54]; hospitalization: [AOR: 1.23; 95%CI: 1.18-1.28]). In terms of COVID-19 disease severity, PLWH were less likely to have mild/moderate illness but more likely to have a severe illness when only controlling for demographics, smoking and BMI, although the estimated risk was obviated after controlling for comorbidities. Interaction terms revealed that the elevated risk was higher among the older age group, males, and black/African American. Interpretation PLWH in the US had an increased risk of COVID-19 hospitalization and mortality comparing with non-PLWH. The adverse COVID-19 outcomes might not only be accounted for by HIV but also by other risk factors that are highly prevalent in PLWH. Funding National Center for Advancing Translational Sciences, National Institute of Allergy And Infectious Diseases, US

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HIV infection and COVID-19 death: population-based cohort analysis of UK primary care data and linked national death registrations within the OpenSAFELY platform

10.1101/2020.08.07.20169490 ◽

2020 ◽

Cited By ~ 3

Author(s):

Krishnan Bhaskaran ◽

Christopher T Rentsch ◽

Brian MacKenna ◽

Anna Schultz ◽

Amir Mehrkar ◽

...

Keyword(s):

Primary Care ◽

Hiv Infection ◽

Cox Regression ◽

Cohort Analysis ◽

Geographical Area ◽

Population Based ◽

People Living With Hiv ◽

Primary Care Data ◽

Living With Hiv ◽

Age And Sex

Background: It is unclear whether HIV infection is associated with risk of COVID-19 death. We aimed to investigate this in a large-scale population-based study in England. Methods: Working on behalf of NHS England, we used the OpenSAFELY platform to analyse routinely collected electronic primary care data linked to national death registrations. People with a primary care record for HIV infection were compared to people without HIV. COVID-19 death was defined by ICD-10 codes U07.1 or U07.2 anywhere on the death certificate. Cox regression models were used to estimate the association between HIV infection and COVID-19 death, initially adjusted for age and sex, then adding adjustment for index of multiple deprivation and ethnicity, and finally for a broad range of comorbidities. Interaction terms were added to assess effect modification by age, sex, ethnicity, comorbidities and calendar time. Results: 17.3 million adults were included, of whom 27,480 (0.16%) had HIV recorded. People living with HIV were more likely to be male, of black ethnicity, and from a more deprived geographical area than the general population. There were 14,882 COVID-19 deaths during the study period, with 25 among people with HIV. People living with HIV had nearly three-fold higher risk of COVID-19 death than those without HIV after adjusting for age and sex (HR=2.90, 95% CI 1.96-4.30). The association was attenuated but risk remained substantially raised, after adjustment for deprivation and ethnicity (adjusted HR=2.52, 1.70-3.73) and further adjustment for comorbidities (HR=2.30, 1.55-3.41). There was some evidence that the association was larger among people of black ethnicity (HR = 3.80, 2.15-6.74, compared to 1.64, 0.92-2.90 in non-black individuals, p-interaction=0.045) Interpretation: HIV infection was associated with a markedly raised risk of COVID-19 death in a country with high levels of antiretroviral therapy coverage and viral suppression; the association was larger in people of black ethnicity.

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Abstract T P137: Temporal Trends in Hospitalization for Ischemic Stroke in the United States, 2000-2010

Stroke ◽

10.1161/str.45.suppl_1.tp137 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Nerses Sanossian ◽

May A Kim-Tenser ◽

Lucas Ramirez ◽

Natalie Valle ◽

Steven Cen ◽

...

Keyword(s):

Ischemic Stroke ◽

Black Women ◽

Temporal Trends ◽

The United States ◽

Population Based ◽

Older Individuals ◽

Hospitalization Rates ◽

The Us ◽

Age Adjusted Rates ◽

Age And Sex

Background: Recent population-based studies have revealed declining ischemic stroke hospitalization rates in the US, particularly among whites, but no study has assessed recent nationwide trends in race/ethnic-, age- and sex-specific stroke hospitalization rates in the US. Aims: To assess temporal trends in race/ethnic-, age-, and sex-specific rates of hospitalization for ischemic stroke in the US. Methods: Temporal trends in hospitalization for ischemic stroke (ICD-9 codes 433.x1, 434, 436) from 2000 to 2010 were assessed among adults ≥25 years using the Nationwide Inpatient Sample. Age-, sex-, and race/ethnic-specific stroke hospitalization rates were calculated using the weighted number of hospitalizations as the numerator and the US civilian population as the denominator. Age-adjusted rates were standardized to the 2000 US Census population. Results: From 2000 to 2010, age-adjusted stroke hospitalization rates decreased from 169 to 138 per 100,000 (overall rate reduction 18.3%). The decline in stroke hospitalizations was driven by the ≥65 age group, with the sharpest decline among 65-84 year olds (Figure). Sex-specific rates showed higher age-adjusted rates in women, with a steeper reduction in women than in men (from 228 to 180 vs. 183 to 157 per 100,000). Race/ethnic-specific trends revealed that hospitalizations decreased for whites and Hispanics but increased for blacks (from 144 to 193 per 100,000 in black men and from 191 to 211 per 100,000 in black women). Discussion: Although overall stroke hospitalizations have decreased in the US, the reduction has been more pronounced among older individuals, whites and Hispanics. Renewed efforts at targeting risk factor control among blacks and middle-aged individuals may be warranted. Figure 1.

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Prevalence and correlates of carotid plaque in a mixed HIV-serostatus cohort in Uganda

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02416-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Prossy Bibangambah ◽

Linda C. Hemphill ◽

Moses Acan ◽

Alexander C. Tsai ◽

Ruth N. Sentongo ◽

...

Keyword(s):

Carotid Plaque ◽

Population Based ◽

Sub Saharan Africa ◽

Noncommunicable Diseases ◽

Control Group ◽

People Living With Hiv ◽

Atherosclerotic Cardiovascular Disease ◽

Lifestyle Modifications ◽

Cross Sectional ◽

Age And Sex

Abstract Background The extent to which the risk of atherosclerotic cardiovascular disease (ACVD) is increased among people living with HIV (PLWH) in sub-Saharan Africa remains unknown. Setting Cross-sectional analysis nested within the Ugandan Noncommunicable Diseases and Aging Cohort, including PLWH in rural Uganda > 40 years taking antiretroviral therapy (ART) for at least 3 years, and a population-based control group of HIV-uninfected age- and sex-matched persons. Methods We conducted carotid ultrasonography and collected ACVD risk factor data. Our outcome of interest was carotid plaque, defined as > 1.5 mm thickness from the intima-lumen interface to the media-adventitia interface. We fit multivariable logistic regression models to estimate correlates of carotid plaque including HIV-specific and traditional cardiovascular risk factors. Results We enrolled 155 (50.2%) PLWH and 154 (49.8%) HIV-uninfected comparators, with a mean age of 51.4 years. Among PLWH, the median CD4 count was 433 cells/mm3 and 97.4% were virologically suppressed. Carotid plaque prevalence was higher among PLWH (8.4% vs 3.3%). HIV infection (aOR 3.90; 95% CI 1.12–13.60) and current smokers (aOR 6.60; 95% CI 1.22–35.80) had higher odds of carotid plaque, whereas moderate (aOR 0.13, 95% CI 0.01–1.55) and vigorous intensity of physical activity (aOR 0.34, 95% CI 0.07–1.52) were associated with decreased odds of carotid plaque. Conclusion In rural Uganda, PLWH have higher prevalence of carotid plaque compared to age- and sex-matched HIV-uninfected comparators. Future work should explore how biomedical and lifestyle modifications might reduce atherosclerotic burden among PLWH in the region.

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Epidemiological and Clinical Characteristics of Coronavirus Disease 2019 in Shenzhen, the Largest Migrant City of China

10.1101/2020.03.22.20035246 ◽

2020 ◽

Cited By ~ 4

Author(s):

Ying Wen ◽

Lan Wei ◽

Yuan Li ◽

Xiujuan Tang ◽

Shuo Feng ◽

...

Keyword(s):

Clinical Features ◽

Large Population ◽

Population Based ◽

Clinical Severity ◽

Risk Assessments ◽

Severe Illness ◽

Close Monitoring ◽

Population Mobility ◽

Medical Visit ◽

And Control

AbstractWe conducted a retrospective study among 417 confirmed COVID-19 cases from Jan 1 to Feb 28, 2020 in Shenzhen, the largest migrant city of China, to identify the epidemiological and clinical features in settings of high population mobility. We estimated the median incubation time to be 5.0 days. 342 (82.0%) cases were imported, 161 (38.6%) cases were identified by surveillance, and 247 (59.2%) cases were reported from cluster events. The main symptoms on admission were fever and dry cough. Most patients (91.4%) had mild or moderate illnesses. Age of 50 years or older, breathing problems, diarrhea, and longer time between the first medical visit and admission were associated with higher level of clinical severity. Surveillance-identified cases were much less likely to progress to severe illness. Although the COVID-19 epidemic has been contained in Shenzhen, close monitoring and risk assessments are imperative for prevention and control of COVID-19 in future.Article Summary LineWe characterized epidemiological and clinical features of a large population-based sample of COVID-19 cases in the largest migrant city of China, and our findings could provide knowledge of SARS-CoV-2 transmission in the context of comprehensive containment and mitigation efforts in similar settings.

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Population‐based outcome analysis of diffuse large B‐cell lymphoma in people living with HIV infection and competent individuals

Hematological Oncology ◽

10.1002/hon.2536 ◽

2018 ◽

Vol 36 (5) ◽

pp. 757-764 ◽

Cited By ~ 3

Author(s):

Annarita Conconi ◽

Emanuele Zucca ◽

Gloria Margiotta‐Casaluci ◽

Katharine Darling ◽

Barbara Hasse ◽

...

Keyword(s):

Hiv Infection ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Population Based ◽

Outcome Analysis ◽

People Living With Hiv ◽

Large B Cell Lymphoma ◽

Living With Hiv ◽

Large B Cell

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Pancreatic manifestations in rheumatoid arthritis: a national population-based study

Rheumatology ◽

10.1093/rheumatology/keaa616 ◽

2020 ◽

Author(s):

Motasem Alkhayyat ◽

Mohannad Abou Saleh ◽

Mehnaj Aggrawal ◽

Mohammad Abureesh ◽

Emad Mansoor ◽

...

Keyword(s):

Joint Inflammation ◽

Population Based ◽

Systemic Autoimmune Disease ◽

Large Database ◽

Ct Diagnosis ◽

Snomed Ct ◽

Electronic Health Record Data ◽

Increased Risk ◽

The Us ◽

Systematized Nomenclature Of Medicine

Abstract Objectives RA is a systemic autoimmune disease characterized by persistent joint inflammation. Extra-articular manifestations of RA can involve different organs including the gastrointestinal (GI) system. Using a large database, we sought to describe the epidemiology of pancreas involvement in RA. Methods We queried a multicentre database (Explorys Inc, Cleveland, OH, USA), an aggregate of electronic health record data from 26 major integrated US healthcare systems in the US from 1999 to 2019. After excluding patients younger than 18, a cohort of individuals with Systematized Nomenclature of Medicine – Clinical Terms (SNOMED–CT) diagnosis of RA was identified. Within this cohort, patients who developed a SNOMED-CT diagnosis of acute pancreatitis (AP), chronic pancreatitis (CP) and primary pancreatic cancer (PaCa) after at least 30 days of RA diagnosis were identified. Statistical analysis for multivariate model was performed using Statistical Package for Social Sciences (SPSS version 25, IBM Corp) to adjust for several factors. Results Of the 56 183 720 individuals in the database, 518 280 patients had a diagnosis of RA (0.92%). Using a multivariate regression model, patients with RA were more likely to develop AP [odds ratio (OR): 2.51; 95% CI: 2.41, 2.60], CP (OR: 2.97; 95% CI: 2.70, 3.26) and PaC (OR: 1.79; 95% CI: 1.52, 2.10). Conclusion In this large database, we found a modest increased risk of AP and CP among patients with RA after adjusting for the common causes of pancreatitis. Further studies are required to better understand this association and the effect of medications used for RA.

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Relationship between BMI with percentage body fat and obesity in Singaporean adults – The Yishun Study

BMC Public Health ◽

10.1186/s12889-021-11070-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kexun Kenneth Chen ◽

Shiou-Liang Wee ◽

Benedict Wei Jun Pang ◽

Lay Khoon Lau ◽

Khalid Abdul Jabbar ◽

...

Keyword(s):

Prediction Model ◽

Body Fat ◽

Population Based ◽

Overweight And Obesity ◽

Community Dwelling ◽

Percentage Body Fat ◽

High Prevalence ◽

The Us ◽

Prevalence Of Obesity ◽

Age And Sex

Abstract Background The main aim of this study was to the determine relationship between Body Mass Index (BMI) and percentage body fat (BF%) in Singaporean adults, derive a prediction model to estimate BF%, and to report population BF%. The secondary aim was to determine the prevalence of overweight and obesity based on BF% threshold and the new risk categories for obesity in Singaporean population. Methods This was a population-based study of 542 community-dwelling Singaporeans (21–90 years old, 43.1% men). Anthropometry and body composition were assessed. Relationship between BMI and BF% were analysed using multiple regression models. Prevalence of overweight and obesity were estimated using WHO and Singapore Ministry of Health (MOH) Clinical Practice Guidelines for BMI classification, and BF% cut-off points of 25 and 35% for men and women respectively. Results We derived a prediction model to estimate BF% based on BMI, age and sex. The current cohort of Singaporeans when compared to Caucasians in the US and Europe as well as a Singapore cohort from 20 years age have higher BF% when matched for BMI, age, and sex. The overall population-adjusted prevalence of obesity according to WHO International classification (BMI ≥30 kg/m2) was 12.9% (14.9% men; 11.0% women); and 26.6% (30.7% men; 22.8% women) according to the MOH classification (BMI ≥27.5 kg/m2). However, using the BF% cut-off (> 25% for men and > 35% for women) resulted in very high prevalence of obesity of 82.0% (80.2% men; 83.8% women). Conclusion There is a large discrepancy between BF% and BMI measured obesity in Singaporean adults. The results confirmed that Singaporean adults have higher BF% at lower BMI compared to US and Europe white counterparts; and that BF% in our population has increased over two decades.

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