People with HIV may be at risk for severe COVID-19, in-hospital mortality

People living with HIV (PLHIV) are at an increased risk of presenting with severe or critical illness* at hospital admission or dying following hospitalization for COVID-19, according to a study from the WHO** Global Clinical Platform.

“HIV infection is a significant independent risk factor for both severe or critical COVID-19 presentation at hospital admission and in-hospital mortality. Among PLHIV, male sex, age >65 years, diabetes, and hypertension were associated with an increased risk of more severe and fatal COVID-19,” said study author Dr Silvia Bertagnolio from the Department of HIV, Hepatitis, and STI Programmes, WHO, Geneva, Switzerland, at IAS 2021.

The results were based on analysis of anonymized individual-level clinical data of 268,412 patients hospitalized with suspected or confirmed COVID-19 in 37 countries between January 2020 and April 2021. Twenty-four countries provided data on PLHIV; of 168,649 hospitalized individuals, 9.2 percent (n=15,522) were PLHIV (mean age 45.5 years, 37.1 percent male).

Almost 92 percent of PLHIV were on antiretroviral therapy (ART). About 36 percent had severe or critical COVID-19 at hospital admission (89.8 percent age ≤65 years, 39.1 percent male). The most frequent comorbidities were hypertension (33.2 percent), diabetes (22.7 percent), and obesity (16.9 percent).

The mean duration between hospital admission and discharge or death was 9.5 days. The in-hospital mortality rate among PLHIV with a known outcome was 23.1 percent. In-hospital mortality was 34.9 percent among PLHIV who presented with severe or critical COVID-19 and 16.8 percent among those who presented with mild-to-moderate disease.

After adjusting for age, sex, and comorbidities, HIV infection was associated with a 13 percent increased risk of presenting with severe or critical COVID-19 disease (adjusted odds ratio [adjOR], 1.13, 95 percent confidence interval [CI], 1.09–1.17). [IAS 2021, abstract PEBLB20]

After adjusting for the other risk factors in the model, age >65 years, male sex, and presence of diabetes or hypertension were associated with an increased risk of PLHIV presenting with severe or critical illness (adjORs, 1.62, 1.21, 1.10, and 1.54, respectively).

After adjusting for age, sex, disease severity, and comorbidities, HIV infection was associated with a 30 percent elevated risk of in-hospital mortality (adjusted hazard ratio [adjHR], 1.30, 95 percent CI, 1.24–1.36).

After adjusting for other risk factors in the model, factors associated with an increased risk of in-hospital mortality among PLHIV were age >65 years (adjHR, 1.82), male sex (adjHR, 1.21), and the presence of diabetes (adjHR, 1.50) or hypertension (adjHR, 1.26).

The researchers acknowledged that information on ART use was not available for 40 percent of patients, and that certain relevant risk factors were not factored in the analysis.

The findings should have bearing on COVID-19 vaccination programmes, said IAS President and IAS 2021 International Co-Chair, Professor Adeeba Kamarulzaman from the University of Malaya, Kuala Lumpur, Malaysia.

“This study underscores the importance of countries including all PLHIV in the list of priority populations for national COVID-19 vaccine programmes,” she said.

“The global community must also do much more to bring COVID-19 vaccines to countries around the world with high prevalence of HIV and other diseases. It is unacceptable that as of today, less than 3 percent of the entire African continent has received a single dose of the vaccine and less than 1.5 percent have received both doses,” she added.