COVID-19 symptoms and SARS-CoV-2 infection among people living with HIV in the US: the MACS/WIHS combined cohort study

Figures & data

Table 1 Prevalence of COVID-19 symptoms since the U.S. outbreak started, by HIV serostatus^{^} (administered April–June 2020 and representing past ∼4 months) in the MWCCS

Symptom*	Cumulative prevalence (symptoms since Jan 2020)				Prevalence (have symptom now?)
	All	PLWH	SN	p-value	PLWH	SN	p-value
	N = 3411	N = 2078	N = 1333		N = 2078	N = 1333
Number of symptoms reported				0.006			0.16
0	47	49	43		80	79
1	16	16	16		13	14
2	11	10	12		4	5
≥3	26	25	29		3	2
Have ≥ 1 symptoms	53	51	57	0.002	20	21	0.43
Headache	23	23	24	0.58	4	3	0.11
Myalgias (muscle aches)	19	19	18	0.31	7	5	0.044
Shortness of breath	14	14	13	0.87	4	3	0.55
Chills	11	12	10	0.32	1	0.3	0.024
Felt feverish	13	12	14	0.19	0.3	0.5	0.60
Fever (Temp > 100.4F)	6	6	6	0.83	0.1	0.2	0.97
Loss of taste or smell	6	6	7	0.65	2	2	0.82
Runny nose (rhinorrhea)	23	20	27	<.001	6	9	0.002
Cough	19	18	21	0.022	4	4	0.79
Sore throat	14	12	16	0.005	1	2	0.63
Diarrhea	13	12	13	0.25	2	2	0.19
Nausea or vomiting	8	9	8	0.37	1	0.5	0.059
Abdominal pain	7	8	7	0.93	2	1	0.034

^{^}PLWH = People Living With HIV; SN = HIV Seronegative.

*More than one symptom could be reported per participant.

Table 2 Cumulative prevalence of SARS-CoV-2 infection via PCR-based testing at time of survey completion (April–June 2020), by HIV status^{^} among MWCCS participants

	N	Percent			p-value
		All	PLWH	SN
		N = 3411	N = 2078	N = 1333
Tested for SARS-CoV-2∼	441	12.9	13.4	12.2	0.33
SARS-CoV-2 test result (self-report among those tested)					0.08
Negative	400	90.7	88.8	93.9
Positive*	41	9.3	11.2	6.1
Hospitalized because of COVID-19, difficulty breathing, or respiratory infection (since January 2020)	59	1.7	1.8	1.6	0.58
Among hospitalized, % SARS-CoV-2 tested
Not tested for SARS-CoV-2	26	44	45	43	0.47
Positive SARS-CoV-2 test	12	20	16	29
Negative SARS-CoV-2 test	21	36	39	29
Among those hospitalized:
Days from admission to discharge: median IQR	53	5 (3, 7)	5 (3, 7)	5 (4, 10)	0.55
Now recovered and are symptom free?					0.66
Yes, recovered and symptom free	41	69.5	71.1	66.7
Feeling better but not completely recovered	17	28.8	26.3	33.3
Not feeling better	1	1.7	2.6	0.0

^{^}PLWH = People Living With HIV; SN = HIV Seronegative.

∼During the time this survey was collected SARS-CoV-2 antibody testing was not available outside of research settings and all SARS-CoV-2 tests are assumed to represent PCR tests.

*Medical record abstraction to confirm self-reported test results was part of the protocol but was not yet available for many participants at time of this analysis. Of the 41 self-reported positive SARS-CoV-2 tests, records were received for 12 (all confirming positive status) by time of this publication; other records were not yet received.

Table 3 Reasons not tested for SARS-CoV-2 infection among those not tested by HIV serostatus^{^}

	N	Prevalence			p-value
		All	PLWH	SN
		N = 2938	N = 1781	N = 1157
Not having any symptoms	2415	82.2	81.0	84.0	0.04
No testing available	865	29.5	26.8	33.5	<.001
Not knowing where to go for testing	476	16.2	16.5	15.8	0.65
Not having transportation to get to or from a medical visit	142	4.8	5.4	3.9	0.06
Worried about not being able to pay for the test	103	3.5	3.5	3.5	0.93
Told by a healthcare provider to self-isolate instead of testing	99	3.4	3.6	3.0	0.40
Not having time or not being able to take off work	39	1.3	1.3	1.4	0.83
Not having someone to watch your children or other people in your care	24	0.8	0.8	0.9	0.82
Other reason (additional self-reported answers)	351	12.0	11.8	12.2	0.75
Other*: Not needed	96	3.3	3.2	3.5	0.64
Other*: Afraid	55	1.9	1.9	1.9	0.92
Other*: Do not trust the test	39	1.3	1.1	1.6	0.23
Other*: Too hard	36	1.2	1.2	1.2	0.95
Other*: Told not needed	28	1.0	1.1	0.8	0.43
Other*: Already had COVID-19	14	0.5	0.3	0.8	0.06

^{^}PLWH = People Living With HIV; SN = HIV Seronegative. More than one reasons could be reported per participant.

*There was an open-ended response option for participants who reported “taking other steps” to write in additional reasons. These answers were categorized for presentation. As these reasons were volunteered by a subsample of participants, and not specifically asked about, the prevalence of these behaviors likely represent an underestimate.

Table 4 Predictors of SARS-CoV-2 positivity (PCR-based test) among 433 MWCCS participants tested at the time of this survey April–June 2020

	Unadjusted OR (95% CI)	Adjusted OR∼ (95% CI)
HIV Serostatus: SN	REF	REF
PLWH	1.92 (0.92, 4.03)	2.22 (1.01, 4.85)
Age: per 10-year increase	0.96 (0.72, 1.30)
Race: White non-Hispanic	REF
Black non-Hispanic	1.06 (0.50, 2.24)
Hispanic, any race	1.63 (0.66, 4.02)
Region: West (California)	REF	REF
Northeast (New York)	8.53 (3.15, 23.11)	8.16 (2.97, 22.41)
South	1.97 (0.58, 6.69)	1.54 (0.45, 5.31)
Mid-Atlantic/Midwest	2.37 (0.88, 6.33)	2.18 (0.80, 5.89)
CD4 cell count (cells/mL): per 100 cells/mm^3 increase	1.04 (0.93,1.18)
Currently on ART	1.17 (0.33, 4.12)
People in household: Live alone	REF	REF
Live with ≥1 other people	2.87 (1.18, 7.00)	2.95 (1.18, 7.40)
Symptoms (compared to those without each symptom)
Loss of taste or smell	10.9 (5.5, 22.0)	10.5 (4.9, 22.4)
Muscle aches	7.9 (3.8, 16.8)	7.4 (3.4, 16.3)
Chills	7.8 (3.9, 15.5)	6.6 (3.2, 14.0)
Fever	6.0 (3.0, 11.9)	5.5 (2.6, 11.6)
Felt feverish	2.8 (1.5, 5.4)	3.0 (1.5, 6.1)
Headache	4.9 (2.4, 9.9)	4.8 (2.3, 10.1)
Cough	4.2 (2.1, 8.3)	3.7 (1.8,7.6)
Sore throat	4.0 (2.1, 7.7)	3.7 (1.8, 7.6)
Nausea or vomiting	3.6 (1.8, 7.4)	2.8 (1.3, 6.1)
Diarrhea	3.3 (1.7, 6.4)	3.2 (1.5, 6.5)
Shortness of breath	2.6 (1.3, 4.9)	2.0 (0.97, 3.9)
Abdominal pain	2.3 (1.02, 5.1)	1.7 (0.73, 4.1)
Runny nose	0.84 (0.42, 1.7)	0.87 (0.42, 1.8)

∼Multivariate analysis included HIV serostatus, region, and living alone. Each symptom listed was included one by one in the model adjusting for these three risk factors.

Figure 1 Prevalence of SARS-CoV-2 positivity among MWCCS participants tested by study site and HIV serostatus∼

∼Number tested at each site is shown below each bars, by HIV status. There were 41 SARS-CoV-2 positive cases, this included 16 cases in New York (11 PLWH and 5 SN), 2 PLWH cases in Pennsylvania, 4 cases in Georgia (3 PLWH and 1 SN), 1 PLWH case in Florida, 7 PLWH cases in Illinois, 4 cases in Maryland (2 PLWH and 2 SN), 6 cases in California (4 PLWH and 2 SN), and 1 PLWH case in Washington DC. Fischer’s Exact test was used for the p-value for the difference in percent positive by site.