AIDS 2022: People living with HIV are at increased risk of severe Covid-19

Since the beginning of the Covid-19 pandemic, there have been questions about whether people living with HIV are at higher risk of complications, more serious conditions and/or death. Although evidence has shown that HIV infection alone is not an additional factor in mortality, the issue remains debated.

In one of the presentations of 24th International AIDS Conferencedata from the World Health Organization (WHO) on the characteristics and outcomes of hospitalized Covid-19 patients were presented.

Results

The WHO database collected information on 338,566 people hospitalized with Covid-19 in 50 countries. Of the 197,479 people with information on their HIV status, 16,955 (8.6%) were people living with HIV, of whom 94.6% resided in Africa, 37.1% were male and age median was 45.5 years.

Among participants with HIV and Covid-19, 38.3% were admitted with serious or critical conditions and 24.7% died during hospitalization. Interestingly, 91.5% of these HIV-positive patients were on antiretroviral therapy. Certain classic symptoms of Covid-19 have been reported statistically significantly more frequently in people living with HIV, such as fever, dyspnoea, fatigue, headache, chest pain, anosmia and myalgia. Cough, on the other hand, was less frequent.

The presence of comorbidities was also a common finding among HIV-positive people hospitalized with Covid-19, with 52% having 1 to 2 comorbidities in addition to HIV infection and 7.1% with 3 or more. Overall, more people hospitalized with HIV had co-occurring clinical conditions than people not infected with HIV (59% versus 45%; p < 0.0001).

Compared to people without HIV infection, HIV-positive participants had a 15% higher risk of severe or critical illness (adjusted OR = 1.15; 95% CI = 1.10 – 1.20) and a 38% probability higher to be infected. Adjusted OR = 1.38; 95% CI = 1.34 – 1.41). Male sex, age between 45 and 75 years and the presence of chronic heart disease or high blood pressure were factors associated with a higher likelihood of severity in this population, while male sex, age over 18, diabetes, hypertension, neoplasia, tuberculosis, or high blood pressure chronic kidney disease were associated with a higher risk of in-hospital death. The presence of severe immunosuppression – CD4-T lymphocyte count < 200 cells/mm³ – has been presented as a risk factor for mortality independently of viral load.

A sub-analysis conducted only with data from participants who had information about antiretroviral therapy showed that people on ART were 17% less likely to die and 40% less likely to be admitted with serious illness compared to to those who were not on treatment.

However, compared to people without HIV, both those who were on treatment and those who were not had a higher risk of death (adjusted RR = 1.48; 95% CI = 1.39 – 1.57 and adjusted RR = 1.79; 95% CI = 1.48 – 2.16, respectively). Similarly, another sub-analysis with data from individuals with viral load information showed a higher risk of death in both those with viral load < 1000 copies/mL (HR ajusté = 1,77 ; IC à 95 % = 1,57 - 1, 99) et chez ceux avec une charge virale > 1000 copies/mL (adjusted HR = 1.45; 95% CI = 1.32 – 1.58) compared to uninfected people.

Discussion

When the analysis of mortality is split by periods to account for differences in dominant variant, it is observed that, in both uninfected and HIV-infected individuals, there was a significant reduction in the period of dominance of the Ômicron variant compared to the period of the Delta variant. However, this reduction was much less pronounced in people living with HIV, with an absolute difference in mortality of 4.8% (95% CI = 3.1 – 6.5), compared with a difference of 13.0% (95% CI = 12.5 – 13.6) in HIV-free populations.

Check out more of the PEBMED Portal coverage on AIDS 2022:

AIDS 2022: Is TAF as effective as TDF in HIV/HBV co-infected patients?
AIDS 2022: What’s new in the WHO guidelines – PrEP
AIDS 2022: What’s new in the WHO guidelines – Cryptococcal meningitis
AIDS 2022: Doxycycline as STI post-exposure prophylaxis
AIDS 2022: Antiretrovirals and weight gain – more evidence

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