Incidence and Risk Factors for Non-AIDS Comorbidities Following COVID-19 in People Living with HIV in Atlanta, Georgia

Background: Coronavirus disease 2019 (COVID-19) infection rates disproportionately affect persons with underlying health conditions. People living with HIV (PLWH) acquire COVID at a higher rate than those without HIV and may be at risk for developing incident comorbidities after acute infection. Risk factors for, and incidence of, post-COVID non-AIDS comorbidities (NACM) in PLWH remain unknown. Setting: We assessed incidence of and risk factors for post-COVID NACM among PLWH using data from the Emory Center for AIDS Research Registry between March 1, 2020, and September 30, 2022. We assessed 8 NACM: cardiometabolic disease, cardiovascular disease, chronic kidney disease, diabetes mellitus, hypertension, lung disease, neurologic disease, and psychiatric disease. Methods: Incidence of and risk factors for post-COVID NACM were evaluated using Cox proportional hazards regression models. Results: Among 3540 PLWH (median age 51 years, 69% male, 86% Black, median CD4+ T cell count 415 cells/mm 3 , 72% HIV RNA <200 copies/mL), 261 (7%) COVID+. COVID+ participants had a higher baseline NACM burden (38% vs. 9% with > 3 NACM), a longer time to developing any NACM (198 vs 96 days), and similar risk of developing any NACM compared with the COVID- group [hazard ratio (HR) (95%CI) 0.65 (0.45, 0.93)]. Conclusions: PLWH during the COVID pandemic were at risk for incident NACM regardless of COVID infection status. Although limited by small sample size, our findings suggest that the pandemic itself, beyond infection, may have contributed to an increase in post-COVID comorbidities in PLWH, particularly among those with pre-existing comorbidities.