Impact of Lung Disease on COVID-19 Health Outcomes in People Living With HIV

Taiwo O Aremu; Oluwafemi Ajibola; Joseph Akambase; Oluwatosin E Oluwole; Han Lu; Grace Hernandez; Nicholas Hable; Jennifer McKay; Modupeoluwa Owolabi; Olawale Ajibola; Kehinde O Adeyinka

doi:10.7759/cureus.42368

Impact of Lung Disease on COVID-19 Health Outcomes in People Living With HIV

Cureus. 2023 Jul 24;15(7):e42368. doi: 10.7759/cureus.42368. eCollection 2023 Jul.

Authors

Taiwo O Aremu^{1

2

3}, Oluwafemi Ajibola⁴, Joseph Akambase^{5

6}, Oluwatosin E Oluwole⁶, Han Lu⁷, Grace Hernandez⁶, Nicholas Hable⁸, Jennifer McKay⁸, Modupeoluwa Owolabi⁹, Olawale Ajibola¹⁰, Kehinde O Adeyinka¹¹

Affiliations

¹ Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, USA.
² Pediatric Hematology and Oncology, University of Minnesota Masonic Children's Hospital, Minneapolis, USA.
³ Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, USA.
⁴ Pulmonary and Critical Care Medicine, Louisiana State University Health Sciences Center, New Orleans, USA.
⁵ Internal Medicine, Hennepin County Medical Center, Minneapolis, USA.
⁶ Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, USA.
⁷ Biostatistics, School of Public Health, University of Minnesota, Minneapolis, USA.
⁸ Medicine, University of Minnesota, Minneapolis, USA.
⁹ Internal Medicine, Saint Michael's Medical Center, Newark, USA.
¹⁰ Medicine, American University of St. Vincent School of Medicine, Kingstown, VCT.
¹¹ Radiation Oncology, University College Hospital (UCH), Ibadan, NGA.

Abstract

Introduction COVID-19 most commonly causes pulmonary/lung infection, and these pulmonary diseases can complicate HIV infection. Underlying pulmonary diseases in people living with HIV (PLWH) could affect health outcomes if infected with COVID-19. Therefore, this study was designed to determine the impact of pulmonary diseases on the health outcomes of PLWH that were infected with COVID-19. Materials and methods We conducted a retrospective study to assess the impact of superimposed COVID-19 infection on pre-existing lung pathologies in patients living with human immunodeficiency virus (HIV) infection using data from the Minnesota Fairview network from January 1, 2020 to December 31, 2022. Ordinal logistic regressions were used to determine the effect of lung comorbidities on COVID-19 severity, COVID-19-specific mortality, and all-cause mortality, adjusting for patient age and gender. Results Two hundred sixteen PLWH tested positive for COVID-19. 24.54% of these patients had one or more pulmonary diseases, including asthma, chronic obstructive pulmonary disease (COPD), and other lung diseases (interstitial lung diseases and pulmonary hypertension). The severity of COVID-19 outcomes was evaluated by the ranking of patients' medical records of testing positive, admitted to the hospital, being admitted to the ICU, and death. COVID-19-specific and all-cause mortality were evaluated separately. PLWH with underlying asthma or COPD was not associated with increased all-cause or COVID-19-specific mortality. Interstitial lung disease or pulmonary hypertension was significantly associated with poor health outcomes for COVID-19-specific mortality and all-cause mortality (Fisher's Exact p-value <0.001), with ICU admissions accounting for the most impact. Using the multivariate models, interstitial lung disease and pulmonary hypertension was significantly associated with an increased risk of more severe COVID-19 outcomes and COVID-19-specific mortality (OR=6.6153, CI=2.5944, 17.0795, p-value < 0.001). Interstitial lung disease and pulmonary hypertension were also significantly associated with an increased risk of more severe COVID-19 outcomes and all-cause mortality (OR=5.0885, CI=2.0590, 12.5542, p-value < 0.001). Conclusions To mitigate the poor outcomes associated with interstitial lung diseases and pulmonary hypertension in PLWH due to COVID-19, healthcare providers must educate their patients about safety measures against the COVID-19 vaccine. They can also encourage the COVID-19 vaccine uptake among their eligible patients.

Keywords: all-cause mortality; asthma; chronic obstructive pulmonary disease (copd); coronavirus 2019 (covid-19); covid-19-specific mortality; human immunodeficiency virus (hiv) infection; interstitial lung disease; people living with hiv (plwh); pulmonary disease; pulmonary hypertension.