Long COVID Between People With and Without HIV: a Statewide Cohort Analysis

Background This study aims to compare the risks of a panel of long COVID manifestations between people with HIV (PWH) and people without HIV (PWoH). Methods Using integrated statewide electronic health record data from the HIV cohort and COVID-19 tester cohort, we identified COVID-19-positive individuals by HIV status between March 02, 2020, and January 15, 2022, in South Carolina. A total of 13 diagnosis groups encompassing 131 potential long COVID categories were identified. We used inverse probability weighting based on propensity scores to balance covariates between the PWH and PWoH, including age, sex, race, and vaccination status. Cox Proportional Hazard regression models were used to estimate the risk of each diagnosis group examined. Results Among a total of 838,520 COVID-19 positive individuals, 2,662 were with HIV, and 835,858 were without HIV. The prevalence of any long COVID diagnosis was 16.3% and 10.6% for PWH and PWoH, respectively. Compared with PWoH, PWH were found to be at a higher risk of at least one of the long COVID diagnosis groups (HR = 1.29, 95%CI: 1.09-1.54) and the highest risk was for diseases of the nervous system (HR = 2.04, 95%CI: 1.42-2.92), followed by mental disorders (HR = 1.78, 95%CI: 1.12-2.82) and respiratory system (HR = 1.78, 95%CI: 1.18-2.69). Conclusions Our study highlights the consistent and elevated LC burden in PWH, emphasizing the importance of sustained follow-up for COVID-19 survivors to improve their clinical outcomes and prevent morbidity of LC.