HIV Infection Increases Odds of Severe COVID-19

People living with HIV are at increased risk for severe COVID-19 at hospital admission and in-hospital mortality compared to those without HIV, according to a paper published in The Lancet.

Investigators from Switzerland used World Health Organization data from January 2020-July 2021 to determine whether people living with HIV with COVID-19 had increased odds of severe symptoms and in-hospital mortality compared to HIV-negative patients. The study authors noted that HIV patients have underlying immune issues that put them at risk for severe disease.

The study authors identified 19,655 people living with HIV and 180,524 people that were HIV-negative who were submitted to the WHO Global COVID-19 Clinical Platform during their study period. The population included patients from 38 countries. A majority of the patients living with HIV were from Africa, about 2/3 were female, and the mean age was about 45 years. Nearly all of the patients living with HIV were on antiretroviral therapy (ART), the study authors also reported.

The investigators found that 93% of HIV-negative patients and 96% of HIV patients were admitted to hospitals with lab-confirmed COVID-19 cases. Patients with HIV were more likely to be female and younger than 45 years compared to those without HIV. The study authors also observed that at least 1 underlying condition was more frequent among those with HIV compared to those without. However, they wrote that conditions such as hypertension, neurological disorders, obesity, and diabetes were more frequent in patients that were HIV-negative.

For HIV patients, the most frequent COVID-19 symptoms were cough, fever, and shortness of breath, the study authors learned. They also observed more frequent use of corticosteroids and anticoagulants among HIV patients compared to those without HIV.

Nearly 40% of HIV patients were admitted to the hospital in severe or critical conditions, the study authors said; furthermore, 24% of those patients died. The severe or critical patients were more likely to be older than 45 years, male, and more likely to have diabetes, hypertension, malignancies, cardiac disease, and kidney disease.

The study authors said that having asthma, chronic cardiac, pulmonary and neurological conditions, and being a current smoker did not differ significantly between the groups, but individuals who died in the hospital had higher proportions of diabetes, hypertension, tuberculosis, chronic kidney disease, and malignancies. Those patients with HIV who died were more likely to be admitted with severe or critical disease than those with mild to moderate disease.

After considering age, sex, disease severity at admission, and underlying conditions, the study authors determined that patients with HIV were 38% more likely to die than those without HIV. Additionally, having HIV was associated with 15% increased odds of severe or critical presentation compared to HIV-negative individuals, the study authors said. Median time from hospitalization to death was shorter in those with HIV and severe presentation compared to those without HIV, they said. But for those with mild to moderate presentation, median time from hospitalization to mortality was longer in those with people with HIV compared to those without HIV.

“We found that underlying conditions are common and more frequent among people living with HIV than the general population,” the study authors concluded. “Alongside the response to COVID-19, it is thus critical to maintain access to essential health services for this vulnerable group.”