Age, sex, syphilis risk factors for COVID-19 in PLHIV

Among people living with HIV (PLHIV), young women and patients with active syphilis appeared to be at an elevated risk of contracting COVID-19, according to a cross-sectional study presented at HIV Glasgow 2022.

The cohort consisted of 5,476 consecutive PLHIV who attended the HIV unit at the Hospital Clinic of Barcelona, Barcelona, Spain, between November 2020 and May 2021. Patients who were vaccinated against COVID-19 were excluded.

A total of 4,400 patients were included in the analysis (median age 48 years, 84 percent male, 57 percent European, 68 percent MSM*). Seventeen percent had a history of AIDS-defining events. Ninety-eight percent of patients were on antiretroviral treatment (ART), 92 percent of whom had undetectable plasma HIV RNA viral loads (<50 copies/mL). Median CD4 and CD8 counts at baseline were 673 and 782 cells/mm³. Among ART recipients, 61 percent were receiving an integrase strand transfer inhibitor (INSTI)-based regimen. Fifty-seven percent were on emtricitabine (FTC)/tenofovir alafenamide (TAF) and 5 percent on FTC/tenofovir disoproxil fumarate (TDF).

Eighteen percent of patients (n=780) tested positive for SARS-CoV-2 (at least one positive IgG/IgM/IgA antibody). Seventy-one, 62, and 57 percent were IgG-, IgM-, and IgA-positive, respectively. [HIV Glasgow 2022, abstract MO43]

Risk factors identified

Women aged 18–34 years had a higher risk of infection than men in the same age category (adjusted rate ratio [adjRR], 1.719). Conversely, men aged 35–49, 50–64, and ≥65 years had a lower risk of infection compared with men aged 18–34 years (adjRRs, 0.837, 0.651, and 0.648, respectively; p=0.0004).

MSM or bisexual patients were at an elevated risk of SARS-CoV-2 infection (adjRR, 1.378; p=0.0024), as were patients from the Americas (adjRR, 1.659) or other parts of the world (adjRR, 1.601; p<0.0001 vs Europe). Transsexual patients were not at elevated risk of SARS-CoV-2 infection (adjRR, 0.937; p=0.6871).

History of AIDS-defining events (adjRR, 1.028; p=0.7953), undetectable viral loads (adjRR, 1.078; p=0.5664), and CD4 and CD8 counts (adjRR, 0.995; p=0.4156 and adjRR, 0.994; p=0.2044, respectively [per 50-unit increase]) were not tied to the risk of SARS-CoV-2 infection. However, patients with active syphilis were at an elevated risk (adjRR, 1.507; p=0.0001).

Being on ART, type of ART, and type of nucleoside reverse transcriptase inhibitor (NRTI) backbone therapy was not associated with an increased risk of SARS-CoV-2 infection.

Who is at risk?

PLHIV have a higher risk of SARS-CoV-2 infection, though the risk factors for infection in this population is unknown, presented Professor José Miró from the Hospital Clinic of Barcelona and University of Barcelona, Spain.

“The protective role of ART, and in particular of TDF, is controversial, being confirmed by some cohort studies, but not others,” he added.

“[In this study,] neither ART nor the use of TDF was protective against SARS-CoV-2 infection,” he said. “SARS-CoV-2 infection was associated with non-European young MSM or women, and in PLHIV with … syphilis.”

Miró acknowledged that data on prior SARS-CoV-2 infection in this population was lacking and that the study did not have adequate patients with CD4 counts <200 cells/mm³ as they were among the first to be vaccinated against COVID-19. There was also no data on the risk of severe COVID-19 and the outcomes were not compared with that of the general population. The high rate of ART use in this cohort also prevents the results from being generalized to individuals not on ART.