Date of Award

Summer 2025

Language

English

Embargo Period

7-28-2025

Document Type

Dissertation

Degree Name

Doctor of Public Health (DrPH)

College/School/Department

Department of Epidemiology and Biostatistics

Program

Public Health

First Advisor

Dr. Mark H Kuniholm

Second Advisor

Dr. Carol-Ann Swain

Committee Members

Dr. Mark H Kuniholm, Dr. James Tesoriero, Dr. Carol-Ann Swain

Keywords

COVID-19, HIV/AIDS, People Living with diagnosed HIV/AIDS, NCD, Chronic Disease

Subject Categories

Cardiovascular Diseases | COVID-19 | Epidemiology | Infectious Disease | Nutritional and Metabolic Diseases | Virus Diseases

Abstract

Background: People living with diagnosed HIV (PLWDH) have a higher chance of co-infections and co-morbidities than the general population. When SARS-CoV-2 was first reported in China in December 2019 and later declared a pandemic, it was speculated that PLWDH might be more prone to SARS-CoV-2 infection and severe disease outcomes given their increased vulnerability to other respiratory infections like influenza, pneumococcal pneumonia and tuberculosis. However, several facets of COVID-19 disease in PLWDH are incompletely understood, including whether non-communicable diseases (NCDs) are strong risk factors for severe disease outcomes and death as they are in the general population.

Methods: The data for my doctoral dissertation were collected by the New York State COVID-19 diagnosis and hospitalization study for PLWDH, which procured data from the Electronic Clinical Laboratory Reporting System (ECLRS), the Health Information Exchange (HIE), manual electronic medical record (EMR) reviews, and the New York State Electronic HIV Management System (NYEHMS). Statistical methods included survival analyses using Cox proportional hazards regression models in which hazard ratios were calculated for associations of NCD’s with death, intensive care unit (ICU) admission and mechanical ventilation among the PLWDH and people living without HIV who were hospitalized for COVID-19 during March 10, 2020, through June 6, 2020. The association between the main exposure and the outcomes were adjusted for age, sex at birth, race/ethnicity, smoking status and alcohol consumption.

Results: PLWDH had a higher prevalence of cardiovascular disease and renal disease, whereas people without diagnosed HIV had a higher prevalence of hypertension, diabetes mellitus and obesity and overweight. None of the NCDs was significantly associated with death, ICU admission or mechanical ventilation among PLWDH. Among people without HIV, diabetes mellitus was significantly associated with death, but not with ICU admission or mechanical ventilation. There was no interaction observed between NCD’s and HIV status, age and sex of the study population in the whole sample, and CD4 count, viral suppression and receipt of anti-retroviral therapy and outcome in PLWDH group.

Conclusion: In this analysis, PLWDH with select NCD’s did not have a higher risk or had a similar risk for mortality, requiring ICU admission or mechanical ventilation due to COVID-19 in comparison with people without HIV/AIDS and COVID-19. This could be plausible as PLWDH in this sample could have been regular in the care cascade for receiving services related to HIV/AIDS, which is seen in the form of majority of PLWDH been receipt of ARV, maintaining a CD4 count >200 and virally suppressed. With more studies on COVID-19 among PLWDH happening across the globe, much new evidence on associations of NCD’s and severe outcomes related to COVID-19 will be available in the future.

License

This work is licensed under the University at Albany Standard Author Agreement.

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