A study published in Clinical Infectious Diseases showed that HIV-positive people hospitalised with coronavirus disease 2019 (COVID-19) had an age-adjusted 47% higher risk of day-28 mortality compared with HIV-negative individuals. In addition, among people aged <60 years, HIV-positive status more than doubled the risk of mortality after adjusting for sex, ethnicity, age, baseline date, comorbidities, and disease severity at presentation.
Anna Maria Geretti, MD, University of Liverpool, Liverpool, United Kingdom, and colleagues compared the presentation characteristics and outcomes of adults with and without HIV who were hospitalised with COVID-19 at 207 centres across the United Kingdom.
Among 47,592 patients, 122 (0.26%) had confirmed HIV infection, of whom, 112 (91.8%) had a record of antiretroviral therapy. At presentation, HIV-positive people were younger (median, 56 vs 74 years) and had fewer comorbidities overall. A lower prevalence of cardiac, pulmonary and rheumatological disease, dementia, and malignancy, but higher rates of moderate/severe liver disease were observed in the HIV-positive group, compared with HIV-negative group. The prevalence of chronic renal disease, diabetes and hematological disease was similar between both groups.
Further, patients within the HIV-positive group were more likely to have systemic symptoms (89.3% vs 68.5%) and higher lymphocyte counts (median, 1.0 x x109 /L vs 0.9 x x109 /L; P < 0.001) and C-reactive protein levels (median, 107 vs 83 mg/L; P = 0.02).
The study data showed that the cumulative day-28 mortality was similar in the HIV-positive and HIV-negative groups (26.7% vs 32.1%; P = 0.16). However, in those under 60 years of age, HIV-positive status was associated with increased mortality (21.3% vs 9.6%; P < 0.001). Further, mortality was found to be higher among people with HIV after adjusting for age (adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.01-2.14; P = 0.05), and the association persisted after adjusting for other variables including sex, ethnicity, and major comorbidities (aHR 1.69; 95% CI 1.15-2.48; P = 0.008) and when restricting the analysis to people aged <60 years (aHR 2.87; 95% CI 1.70- 4.84; P < 0.001).
“Whilst there is a recognized interplay between HIV and comorbidities, neither omitting the adjustment for comorbidities nor adjusting for separate comorbidities modified the association,” the authors wrote. “[People with HIV] had fewer comorbidities, notably lower prevalence of chronic pulmonary disease and malignancies, and this is largely a function of their younger age. HIV-positive people who died were older and were more likely to suffer from obesity and diabetes with complications than those who survived to discharge. Similar trends have been seen in the general population. While these observations highlight the importance of obesity and diabetes as cofactors, the increased risk of COVID-19 related mortality in [people with HIV] was not merely due to the presence of promoting comorbidities.”
“Our data are limited by the relatively small number of people with HIV included in the study and the findings should be interpreted with caution. Nonetheless, after careful considerations, our analysis of the outcomes of patients hospitalised with COVID-19 in the UK shows an increased risk of day-28 mortality due to HIV-positive status,” the authors concluded. “As the pandemic continues to spread, including in areas of increased HIV prevalence, it is important to record the HIV status of people hospitalised with COVID-19 and gather further data to corroborate our findings and confirm the population-specific determinants of outcomes. Meanwhile, emphasis for [people with HIV] should be placed on early HIV diagnosis, prompt [antiretroviral therapy] initiation, and optimised screening for and control of comorbidities including obesity and diabetes. “