5 research outputs found
; a nation‐wide register‐based study
No full textObjectives: To assess the outcome of patients hospitalized with COVID-19 by HIV status and risk factors for severe COVID-19 in people living with HIV (PWH), we performed a nationwide cohort study using register data. Methods: All people aged ≥18 years hospitalized with a primary COVID-19 diagnosis (U07.1 or U07.2) in Sweden between February 2020 and October 2021 were included. The primary outcome was severe COVID-19 [intensive care unit (ICU) admission or 90-day mortality]. Secondary outcomes were days in hospital and ICU, complications in hospital, and risk factors for severe COVID-19 in PWH. Regression analyses were performed to assess severe COVID-19 by HIV status and risk factors. Results: Data from 64 815 hospitalized patients were collected, of whom 121 were PWH (0.18%). PWH were younger (p < 0.001), and larger proportions were men (p = 0.014) and migrants (p < 0.001). Almost all PWH had undetectable HIV-RNA (93%) and high CD4 T-cell counts (median = 560 cells/μL, interquartile range: 376–780). In an unadjusted model, PWH had statistically significant lower odds of severe COVID-19 compared with patients without HIV [odds ratio (OR) = 0.6, 95% confidence interval (CI): 0.34–0.94], but there was no significant difference after adjusting for age and comorbidity (adjusted OR = 0.7, 95% CI: 0.43–1.26). A statistically significant lower proportion of PWH (8%, 95% CI: 5–15%) died within 90 days compared with those without HIV (16%, 95% CI: 15–16%, p = 0.024). There was no statistically significant difference in days in hospital and complications during the hospital stay between PWH and patients without HIV. Conclusions: In this nationwide study including well-treated PWH, HIV was not a risk factor in hospitalized patients for developing severe COVID-19
Sociodemographic factors influencing SARS-CoV-2 vaccination uptake in people with and without HIV : Insights from a Swedish Nationwide cohort
No full textBACKGROUND: There is limited data regarding SARS-CoV-2 vaccine uptake in people with HIV (PWH) compared to people without HIV (PWoH).METHODS: Swedish nationwide study of individuals born 1930-2003, assessing SARS-CoV-2 vaccine uptake of 1-5 doses by HIV-status from first SARS-CoV-2 vaccination (2020-12-27) until 2023-02-23. PWH were categorized by prioritization: clinically vulnerable (CD4+ T-cells 200copies/mL), and not prioritized (non-vulnerable PWH). Relative risks (adjRR) for doses 1-5 were estimated using modified Poisson regression, adjusted for sociodemographics, SARS-CoV-2 infections, and comorbidities.RESULTS: 7233 non-vulnerable PWH, 435 clinically vulnerable PWH, and 8,168,340 PWoH were included. While unadjusted 3-dose uptake was lower in both PWH groups compared to PWoH, adjusted analysis showed higher uptake in non-vulnerable PWH (adjRR1.17, 95 % CI 1.15-1.19), with similar trends in clinically vulnerable. An interaction between country of birth and HIV-status was identified (p < 0.001). Migrants with HIV had higher 3-dose uptake vs. migrants without HIV, but were less likely vaccinated than Swedish-born with HIV. Among people ≥65 years old, PWH were less likely to receive 3 or more doses compared to PWoH ≥65 years (dose 5: adjRR 0.90, 95 % CI 0.85-0.96).CONCLUSIONS: We found lower vaccination uptake in migrants, irrespective of HIV-status, consistent with previous studies. Most concerningly we identified a lower vaccine uptake among people with HIV who were 65 years or older. This nationwide study highlights the need for targeted vaccination strategies and interventions that address both HIV-status and demographic factors
Outcomes of the COVID-19 pandemic in chronic lymphocytic leukemia : focus on the very early period and Omicron era
No full textIndividuals with chronic lymphocytic leukemia (CLL) face an increased risk for severe COVID-19. This study from Sweden, a country that only had a few mandatory restrictions at the onset of the pandemic, used 10 nationwide registers to compare the risks for severe COVID-19 outcomes of polymerase chain reaction-verified severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections through February 2023 in individuals with and those without CLL. From a population of 8 275 839 (6653 CLL) individuals born between 1930 and 2003, 2 088 163 first infections (1289 CLL) were included. The 90-day all-cause mortality rate and adjusted relative risk (aRR; 95% confidence interval) for individuals with CLL vs the general population was 24.8% (1.95; 1.58-2.41) during wild-type, 17.2% (2.38; 1.58-3.57) during Alpha, 4.1% (0.71; 0.24-2.08) during Delta, and 12.6% (1.49; 1.24-1.78) during Omicron infections. Their mortality during Omicron was 0.6% (<65 years), 5.4% (65-74 years), and 19.7% (≥75 years). Small molecule inhibitors (1.56; 1.03-2.37) and corticosteroid usage (1.45; 1.04-2.02) was associated with increased mortality. Next, we analyzed the all-cause mortality in the capital (Stockholm), widely affected by SARS-CoV-2 at the onset of the pandemic. Mortality in individuals with CLL increased by 55% during the first 6 months of 2020 vs 2019, and the age- and sex-aRR by 30 June was 1.53 (1.09-2.15) for individuals with CLL (P = .02) and 1.29 (1.25-1.33) for the general population (P < .001). Collectively, a significantly increased risk for severe COVID-19 and death was observed among individuals with CLL in Sweden, particularly at the onset of the pandemic when few national protective measures were introduced and also after Omicron emerged, emphasizing the need for a more pro-active pandemic strategy for CLL
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 [Elektronisk resurs]
No full textBackgroundData on the outcomes of COVID-19 in people living with HIV (PLHIV), specifically in relation to vaccination status, are lacking during the Omicron era.MethodsThis nationwide registry-based study included all resident in Sweden &gt;= 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 &gt;= 3 doses), and HIV-status. Analyses were then categorised by time periods of pre-Omicron, Omicron during public testing, and Omicron after public testing.Results1348 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 &gt;= 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.ConclusionsThis 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 POINTPeople 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, &gt;= 3 doses) when adjusting for known risk factors including comorbidities and socioeconomic status.</p
Inborn errors of immunity are associated with increased COVID-19–related hospitalization and intensive care compared to the general population
No full textBackground: It is thought that patients with inborn errors of immunity (IEI) are more susceptible to severe coronavirus disease 2019 (COVID-19) than the general population, but a quantification of this potential risk is largely missing. Objective: We assessed the impact of COVID-19 on patients with IEI. Methods: A nationwide cohort study was performed to estimate the relative risk (RR) for hospitalization, intensive care, and death within 30 days after a positive severe acute respiratory syndrome coronavirus 2 test result in an IEI population (n = 2392) compared to the general population (n = 8,270,705) using data from Swedish national registries. Three time periods were studied: the prevaccination period, and the Alpha/Delta and Omicron periods. Adjustment was made for demographics, income, comorbidities, and vaccination status. Results: During the prevaccination period, 25.2% of the IEI population was hospitalized, compared to 17.5% and 5.2% during the Alpha/Delta and Omicron periods, respectively. For the 3 time periods, the adjusted RR [95% confidence interval] for hospitalization in the IEI population compared to the general population was 3.1 [2.1-4.2], 3.5 [2.4-4.8], and 4.3 [2.5-6.7], respectively. The respective values for intensive care after COVID-19 were 5.6 [2.6-10.8], 4.7 [1.7-10.1], and 4.7 [1.7-10.1] for the 3 periods. Five patients (0.6%) in the IEI population died within 30 days of a positive PCR test result compared to 18,773 (0.2%) in the general population during the 3 study periods. Conclusion: Patients with IEI had a 3 to 4 times higher risk for hospitalization and a 5 times higher risk for intensive care during COVID-19 compared to the general population
