{"doi":"10.1101/2021.07.26.21261028","title":"COVID-19 Disease Severity among People with HIV Infection or Solid Organ Transplant in the United States: A Nationally-representative, Multicenter, Observational Cohort Study","abstract":"ABSTRACT Background Individuals with immune dysfunction, including people with HIV (PWH) or solid organ transplant recipients (SOT), might have worse outcomes from COVID-19. We compared odds of COVID-19 outcomes between patients with and without immune dysfunction. Methods We evaluated data from the National COVID-19 Cohort Collaborative (N3C), a multicenter retrospective cohort of electronic medical record (EMR) data from across the United States, on. 1,446,913 adult patients with laboratory-confirmed SARS-CoV-2 infection. HIV, SOT, comorbidity, and HIV markers were identified from EMR data prior to SARS-CoV-2 infection. COVID-19 disease severity within 45 days of SARS-CoV-2 infection was classified into 5 categories: asymptomatic/mild disease with outpatient care; mild disease with emergency department (ED) visit; moderate disease requiring hospitalization; severe disease requiring ventilation or extracorporeal membrane oxygenation (ECMO); and death. We used multivariable, multinomial logistic regression models to compare odds of COVID-19 outcomes between patients with and without immune dysfunction. Findings Compared to patients without immune dysfunction, PWH and SOT had a greater likelihood of having ED visits (adjusted odds ratio [aOR]: 1.28, 95% confidence interval [CI] 1.27-1.29; aOR: 2.61, CI: 2.58-2.65, respectively), requiring ventilation or ECMO (aOR: 1.43, CI: 1.43-1.43; aOR: 4.82, CI: 4.78-4.86, respectively), and death (aOR: 1.20, CI: 1.19-1.20; aOR: 3.38, CI: 3.35-3.41, respectively). Associations were independent of sociodemographic and comorbidity burden. Compared to PWH with CD4>500 cells/mm 3 , PWH with CD4<350 cells/mm 3 were independently at 4.4-, 5.4-, and 7.6-times higher odds for hospitalization, requiring ventilation, and death, respectively. Increased COVID-19 severity was associated with higher levels of HIV viremia. Interpretation Individuals with immune dysfunction have greater risk for severe COVID-19 outcomes. More advanced HIV disease (greater immunosuppression and HIV viremia) was associated with higher odds of severe COVID-19 outcomes. Appropriate prevention and treatment strategies should be investigated to reduce the higher morbidity and mortality associated with COVID-19 among PWH and SOT.","journal":"medRxiv","year":2021,"id":212984,"datarank":0.5897738449086489,"base_score":3.9318256327243257,"endowment":3.9318256327243257,"self_citation_contribution":0.5897738449086489,"citation_network_contribution":0.0,"self_endowment_contribution":0.5897738449086489,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":50,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.7784,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":404274,"name":"Rena C. Patel","orcid":"0000-0001-9893-5856","position":1,"is_corresponding":false},{"id":78330,"name":"Qulu Zheng","orcid":"0000-0003-2461-7462","position":2,"is_corresponding":false},{"id":49904,"name":"Vithal Madhira","orcid":"0000-0001-5359-1703","position":3,"is_corresponding":false},{"id":571568,"name":"Amy L. Olex","orcid":"0000-0001-8064-521X","position":4,"is_corresponding":false},{"id":369799,"name":"Jessica Y. Islam","orcid":"0000-0002-3690-3848","position":5,"is_corresponding":false},{"id":626296,"name":"Evan French","orcid":"0000-0002-5809-5810","position":6,"is_corresponding":false},{"id":626297,"name":"Teresa Po‐Yu Chiang","orcid":"0000-0003-0601-7420","position":7,"is_corresponding":false},{"id":719149,"name":"Hana Akselrod","orcid":"0000-0002-4284-0599","position":8,"is_corresponding":false},{"id":49910,"name":"Richard A. Moffitt","orcid":"0000-0003-2723-5902","position":9,"is_corresponding":false},{"id":247849,"name":"G. Caleb Alexander","orcid":"0000-0002-5622-2986","position":10,"is_corresponding":false},{"id":626298,"name":"Kathleen M. Andersen","orcid":"0000-0003-2670-800X","position":11,"is_corresponding":false},{"id":626299,"name":"Amanda J. Vinson","orcid":"0000-0002-9345-5252","position":12,"is_corresponding":false},{"id":109430,"name":"Todd T. Brown","orcid":"0000-0001-8599-278X","position":13,"is_corresponding":false},{"id":49893,"name":"Christopher G. Chute","orcid":"0000-0001-5437-2545","position":14,"is_corresponding":false},{"id":6545,"name":"Keith A. Crandall","orcid":"0000-0002-0836-3389","position":15,"is_corresponding":false},{"id":24742,"name":"Nora Franceschini","orcid":"0009-0001-8346-3662","position":16,"is_corresponding":false},{"id":320236,"name":"Roslyn B. Mannon","orcid":"0000-0003-1776-3680","position":17,"is_corresponding":false},{"id":240255,"name":"Gregory D. Kirk","orcid":"0000-0002-7829-1405","position":18,"is_corresponding":false},{"id":626294,"name":"Jing Sun","orcid":"0000-0003-3741-0962","position":0,"is_corresponding":true}],"reference_count":44,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T23:52:31.378994Z","pmid":"34341798","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}