CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

860

COVID-19 Omicron Infection and Severe Outcomes in HIV and Matched Non-HIV Cohorts in Ontario, Canada Ann N Burchell 1 , Catharine Chambers 2 , Lena Nguyen 3 , Curtis L. Cooper 4 , Abigail E. Kroch 5 , Hasina Samji 6 , Cecilia T. Costiniuk 7 , Aslam H. Anis 8 , Jeffrey C. Kwong 2 , Rahim Moinheddin 2 , Sarah A. Buchan 9 , Lawrence Mbuagbaw 10 , Claire E. Kendall 11 , Devan Nambiar 12 , for the COVAXHIV Team 1 Unity Health Toronto, Toronto, Canada, 2 University of Toronto, Toronto, Canada, 3 ICES, Toronto, Canada, 4 Ottawa Hospital Research Institute, Ottawa, Canada, 5 Other Institution – Follow-up needed, N/A, 6 Simon Fraser University, Burnaby, Canada, 7 Research Institute of McGill University Health Centre, Montreal, Canada, 8 CIHR Canadian HIV Trials Network, Vancouver, Canada, 9 Public Health Ontario, Ontario, Canada, 10 McMaster University, Hamilton, Canada, 11 University of Ottawa, Ottawa, Canada, 12 Gay Men's Sexual Health Alliance, Toronto, Canada Background: There is concern that people living with HIV may be at greater risk for COVID-19 infection or severe outcomes, and that vaccination may offer less protection, compared to those not living with HIV. Our aim was to quantify rates of SARS-CoV-2 testing and COVID-19 infection and hospitalization/death in the Omicron period and compare this by HIV and vaccination status. Methods: We identified community-dwelling people living with HIV aged ≥19 years in health administrative databases using a validated algorithm and followed them from January 2, 2022, to March 31, 2023, along with an HIV-negative cohort matched on age, sex, census tract, and immigrant status. Vaccination status was ascertained from the provincial COVID-19 vaccine registry. Most distributed vaccines during this period were monovalent mRNA vaccines. We report rates per 1000 person-years (PY) for time to first PCR testing for SARS CoV-2, PCR-confirmed infection, and COVID-19-related hospitalization/death among HIV and non-HIV matched cohorts, with 95% confidence intervals (CI). Results: A total of 20,978 people living with HIV and 20,978 matched HIV negative individuals were included. Cohorts were comparable by matching factors age (mean 50.5 years), sex (21.9% female), region, and immigrant status (72.3% non-immigrant), and had a similar number of comorbidities. However, people living with HIV were more likely than HIV-negative individuals to have received 3+ doses of SARS-CoV-2 vaccine (31.5% cf 23.9%), recent influenza vaccination (42.9% cf 29.1%), and certain comorbidities: chronic kidney disease (5.9% cf 2.6%), frailty/dementia (5.3% cf 2.7%) or advanced liver disease (3.5% cf 1.2%). Rates of SARS-CoV-2 PCR testing and COVID-19 outcomes were consistently higher among people living with HIV, even when compared within vaccine dose strata (Table). Compared with HIV-negative hospitalized cases (n=100), hospitalized cases who were living with HIV (n=215) were more likely to be vaccinated (88.4% cf 79.0%); they were also younger, more likely to be female or an immigrant, and differed in comorbidities. Conclusion: Timely booster doses and efforts to reduce SARS-CoV-2 exposure remain important for people living with HIV given higher rates of infection and severe outcomes. Limitations include incomplete confounding control and imprecision for severe events which were rare. Ongoing monitoring is needed for more recent vaccine formulations and against newer variants. The figure, table, or graphic for this abstract has been removed. SARS-CoV-2 Infection and Hospitalization in Immunocompromised Children: A Population-Based Study Costanza Di Chiara 1 , Arianna Giugni 2 , Marthe Le Prevost 3 , Elisa Barbieri 1 , Angela Lupatelli 4 , Carlo Giaquinto 1 , Daniele Donà 1 , Anna Cantarutti 2 1 University of Padova, Padova, Italy, 2 University of Milano–Bicocca, Milan, Italy, 3 UCL Great Ormond Street Institute of Child Health, London, United Kingdom, 4 University of Oslo, Oslo, Norway Background: The burden of SARS-CoV-2 infection in immunocompromised children remains unclear due to limited population-based studies. We aimed to assess the incidence of SARS-CoV-2 infection and hospitalization in children with and without immunocompromising conditions. Methods: We conducted a population-based cohort study of children aged 0-14 years in the Veneto region, Italy, from February 2020-May 2023. Data were obtained from an Italian pediatric primary-care database (Pedianet) linked to the Veneto region's hospitalization and COVID-19 nasopharyngeal swab (NPS) registries. Three groups of children were included in this cohort: children with an immunocompromising condition and/or on immunosuppressive treatments (IC), non-immunocompromised children with at least one specific comorbidity other than immunocompromising diseases (non-IC), and healthy children (HC). Adjusted hazard ratios (aHR) and 95% confidence interval (CI) for the risk of SARS-CoV-2 primary infection and COVID-19 vaccine uptake among IC, non-IC, and HC were estimated using Cox proportional hazard models. Models were adjusted for several potential confounders (age, gender, deprivation index, number of visits and antibiotic prescriptions). Hospitalisations' incidence rate

859

Characteristics and Outcomes of Patients with Kidney Transplant Hospitalized for COVID-19 in the US Essy Mozaffari 1 , Aastha Chandak 2 , Andre C. Kalil 3 , Chidinma Chima-Melton 4 , Alpesh N. Amin 5 , Mark Berry 1 , Jason F. Okulicz 1 , Robert L. Gottlieb 6 1 Gilead Sciences, Inc, Foster City, CA, USA, 2 Certara, Inc, New York, NY, USA, 3 University of Nebraska Medical Center, Omaha, NE, USA, 4 University of California Los Angeles, Los Angeles, CA, USA, 5 University of California Irvine, Irvine, CA, USA, 6 Baylor University Medical Center, Dallas, TX, USA Background: Immunocompromising conditions and advanced renal dysfunction are individually risk factors for adverse outcomes from COVID-19. We explored the intersection of these risk factors by examining variations in treatment patterns and mortality among hospitalized COVID-19 patients with a history of kidney transplant. Methods: Patients with a history of kidney transplant (ICD-10-CM: Z94.0) hospitalized in the US for COVID-19 (ICD-10-CM: U07.1) between May 2020-Jan 2023 were identified using the Premier Healthcare Database. Baseline was considered as first two days of hospitalization. We characterized patient demographics, treatment patterns and in-hospital all-cause mortality by chronic kidney disease (CKD) stage as a surrogate for renal allograft dysfunction. Results: Of the 8,785 patients included in this study from 831 hospitals, 55% were White, 27% Black, 40% female with a median age of 62 years [IQR: 52-70]. Key comorbidities included hypertension (90%) and diabetes (60%). Baseline COVID-19 severity included 68% patients with no supplemental oxygen charges, 17% low-flow supplemental oxygen, 10% high-flow/non-invasive ventilation, and 5% invasive mechanical ventilation/ECMO. Patients were hospitalized for a median of 5 days [IQR: 3-10] with 29% admitted to the ICU and 16% mortality rate. Over the variant periods, patient characteristics remained similar except higher supplemental oxygen requirements, ICU stay and mortality rate in the Delta period as compared to Pre-Delta and Omicron. Despite risk of progression, use of COVID-19 treatments was lower with higher CKD stage, and use of triple therapy with remdesivir+dexamethasone with baricitinib/tocilizumab increased with higher supplemental oxygen requirement (Figure). Mortality increased from 14% for CKD Stage ≤2 to 23% for Stage 4 and 18% for Stage 5 (Figure). Conclusion: In this study of kidney transplant recipients hospitalized with COVID-19, the lack of any COVID-19 treatment was seen more often as renal function diminished despite a notable increase in overall mortality observed in tandem with compromised renal function. This study sheds light on a persistent therapeutic gap that has affected these patients historically, attributed to factors such as potential drug interactions, past uncertainties regarding the renal clearance of therapeutics, and existing gaps in medical education and awareness.

Poster Abstracts

861

CROI 2024 265