Role of Immunosuppression in the Risk of Severe COVID-19

Increased hospitalization risk was driven mainly by the high burden of comorbidities in both groups.

For those with immunosuppression or are immunocompromised (ISC), it is well-known that they are at an increased risk for more severe forms of disease. During the time of a global pandemic, like that of the currently ongoing COVID-19 virus, the role to which ISC plays is of significant importance.

It has been suggested that ISC could reduce control of SARS-CoV-2 viremia, as well as having the potential to dampen the severe immune response to the virus. However, this topic has yet to be fully explored and data comparing ISC groups is currently limited.

A recent study has now conducted research that compared the risk of COVID-19 hospitalization amongst patients in 3 ISC groups. The data was presented during the Conference on Retroviruses and Opportunistic Infections (CROI) 2021 virtual sessions.

The data was gathered from 34 sites in the U.S. National COVID Cohort Collaborative (N3C).

The study included 1,300 people with the human immunodeficiency virus (HIV), 2,142 with a solid organ transplant (SOT), and 41 with both HIV and SOT. Investigators compared their risk of COVID-19 against 288,743 patients with COVID-19 without HIV or SOT. All participants who tested positive with COVID-19 did so by way of RT-PCR, antibody test, or diagnostic codes. HIV infection, SOT and comorbidities were defined by conditions/diagnostic codes within 2 years prior to the COVID-19 infection.

In order to meet the hospitalization requirement, participants must have been in inpatient care for between 14 and 45 days after their positive test with COVID-19. Investigators estimated the odds ratio of hospitalization by using a multivariable logistic regression model and adjusting for demographics, study site, and comorbidities.

Of the COVID-19 positive patients, the median age was 41 years, with 46% being male, 47% being non-Hispanic white (NHW), and 17% being non-Hispanic black (NHB). The PWH and SOT patients were more likely to be older, male and have ≥ 3 comorbidities. Overall, 26% of HIV-/SOT- COVID-19 patients were hospitalized. Among the patients with HIV, SOT or both, they had a 2.3, 4.4, or 6.9-fold increased odds of hospitalization, respectively.

Additionally, after adjusting for site and demographics, the risk of severe COVID-19 remained statistically significant.