MWCCS Covid-19 Supplement Activities

Abstract: COVID-19 cases continue to rise, with over 3,000,000 cases and 130,000 deaths in the US and almost 12million cases worldwide to date. Manifestations of SARS CoV-2 infection range from asymptomatic to mild,moderate, or severe disease, and primarily affects the lung, but increasing data suggests involvement of otherorgan and blood systems. Studies document more severe disease and higher mortality among people who areolder and/or have co-morbidities, such as hypertension, diabetes, obesity, and chronic lung disease. However,there is a paucity of data regarding the acquisition, occurrence and severity of infection among people with HIV(PWH). There is also little data to guide prevention and treatment recommendations for this population, manyof whom are older and have comorbidities that may increase not only their risk for acquiring infection, but alsothe morbidity and mortality among those who acquire infection. Moreover, early reports suggest substantialracial disparities in US COVID-19 rates, with increases in mortality among African Americans. The MACS-WIHS Combined Cohort Study (MWCCS), the largest and longest-running observational cohort of men andwomen living with or at risk for HIV in the US provides a unique opportunity to address important knowledgegaps in the acquisition, occurrence, severity and outcomes of COVID-19. The MWCCS is a geographically andracially/ethnically diverse cohort of aging men and women with a high prevalence of risk factors for progressionto severe COVID-19 disease including hypertension, diabetes, obesity, and smoking. The MWCCS has a richbiorepository of specimens, collects rigorous clinical measures including pulmonary, cardiac, kidney,neurocognitive, and physical function, body composition and has performed cohort-wide genome associationstudies. The overarching goal of this application is to understand the impact of the COVID-19 epidemic amongUS men and women with or at risk for HIV infection and to evaluate host factors that contribute to diseaseacquisition, expression, severity and recovery. The proposed studies will determine COVID incidence, short-term and long-term clinical outcomes, including thrombotic and pulmonary sequelae, and how racial andgeographic disparities; immune and genetic risk factors impact these outcomes in the MWCCS.