HIV infection and COVID-19 death: a population-based cohort analysis of UK primary care data and linked national death registrations within the OpenSAFELY platform.
HIV infection and COVID-19 death: a population-based cohort analysis of UK primary care data and linked national death registrations within the OpenSAFELY platform.
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DOI：
10.1016/s2352-3018(20)30305-2
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发表时间：
2021-01
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影响因子：
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通讯作者：
Goldacre B
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作者：
Bhaskaran K;Rentsch CT;MacKenna B;Schultze A;Mehrkar A;Bates CJ;Eggo RM;Morton CE;Bacon SCJ;Inglesby P;Douglas IJ;Walker AJ;McDonald HI;Cockburn J;Williamson EJ;Evans D;Forbes HJ;Curtis HJ;Hulme WJ;Parry J;Hester F;Harper S;Evans SJW;Smeeth L;Goldacre B
艾滋病毒感染是否与COVID-19导致的死亡风险有关尚不清楚。我们的目的是在英国进行一项大规模的基于人群的研究，以调查这种关联。我们做了一项回顾性队列研究。我们代表NHS英格兰工作，使用OpenSAFELY平台分析常规收集的与国家死亡登记相关的电子初级保健数据。我们纳入了2020年2月1日存活并随访的所有成人（年龄≥18岁），并且在此日期之前在全科医生处连续注册至少1年。有艾滋病毒感染初级保健记录的人与没有艾滋病毒的人进行了比较。结果是COVID-19死亡，定义为死亡证明上任何地方出现国际疾病分类10代码U07.1或U07.2。考克斯回归模型被用来估计艾滋病毒感染和COVID-19死亡之间的关联;他们最初根据年龄和性别进行了调整，然后我们增加了多重剥夺指数和种族的调整，然后是广泛的合并症。增加了相互作用项，以评估年龄、性别、种族、合并症和日历时间的效应改变。17 282 905名成年人被包括在内，其中27 480人（0.16%）有艾滋病毒记录。 艾滋病毒感染者更有可能是男性、黑人和来自比一般人口更贫困的地理区域。 研究期间发生了14882例COVID-19死亡，其中25例为艾滋病毒感染者。调整年龄和性别后，艾滋病毒感染者的COVID-19死亡风险高于未感染艾滋病毒者：风险比（HR）2·90（95% CI 1·96-4·30; p<0·0001）。在校正了剥夺、种族、吸烟和肥胖后，这种关联减弱，但风险仍然很高：校正后的HR为2.59（95%CI 1.74 - 3.84; p<0.0001）。有一些证据表明，这种关联在黑人中更大：HR为4.31（95% CI 2.42 - 7.65），而非黑人个体为1.84（1.03 - 3.26）（p-相互作用= 0.044）。英国的艾滋病毒感染者似乎面临着增加的COVID-19死亡风险。随着大流行应对工作的发展，应考虑采取有针对性的政策来应对这一风险。惠康，皇家学会，国家健康研究所，国家健康研究所牛津生物医学研究中心，英国医学研究理事会，英国健康数据研究。
Whether HIV infection is associated with risk of death due to COVID-19 is unclear. We aimed to investigate this association in a large-scale population-based study in England. We did a retrospective cohort study. Working on behalf of NHS England, we used the OpenSAFELY platform to analyse routinely collected electronic primary care data linked to national death registrations. We included all adults (aged ≥18 years) alive and in follow-up on Feb 1, 2020, and with at least 1 year of continuous registration with a general practitioner before this date. People with a primary care record for HIV infection were compared with people without HIV. The outcome was COVID-19 death, defined as the presence of International Classification of Diseases 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; they were initially adjusted for age and sex, then we added adjustment for index of multiple deprivation and ethnicity, and then for a broad range of comorbidities. Interaction terms were added to assess effect modification by age, sex, ethnicity, comorbidities, and calendar time. 17 282 905 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. 14 882 COVID-19 deaths occurred during the study period, with 25 among people with HIV. People living with HIV had higher risk of COVID-19 death than those without HIV after adjusting for age and sex: hazard ratio (HR) 2·90 (95% CI 1·96–4·30; p<0·0001). The association was attenuated, but risk remained high, after adjustment for deprivation, ethnicity, smoking and obesity: adjusted HR 2·59 (95% CI 1·74–3·84; p<0·0001). There was some evidence that the association was larger among people of Black ethnicity: HR 4·31 (95% CI 2·42–7·65) versus 1·84 (1·03–3·26) in non-Black individuals (p-interaction=0·044). People with HIV in the UK seem to be at increased risk of COVID-19 mortality. Targeted policies should be considered to address this raised risk as the pandemic response evolves. Wellcome, Royal Society, National Institute for Health Research, National Institute for Health Research Oxford Biomedical Research Centre, UK Medical Research Council, Health Data Research UK.