Certain Categories of Persons Living with HIV Have Worse COVID-19 Outcomes

Previous reports of the impact of HIV infection on COVID-19's clinical course have left uncertainty about the interactions between those two conditions (NEJM JW Infect Dis Sep 2020; multiple citations). Two new studies provide clarity. In the first, investigators used data from the U.S. National Covid Cohort Collaboration (NC3) data to evaluate COVID-19 outcomes in >1,400,000 persons without HIV and >13,000 persons living with HIV infection (PLHIV). After adjusting for covariates (demographics, smoking, obesity, and comorbidities), PLHIV had a 20% higher risk for hospitalization and a 29% higher risk for death. Among PLHIV, risk for poor outcomes was higher in those who were older, Black, African American, Hispanic, or Latinx as well as those with CD4 counts <200 cells/µL.

In the second study, researchers in Spain utilized linked records from two databases (one with information on >28,000 PLHIV and the other with clinical data including COVID-19 status and comorbidities). Linked data were available for >13,000 persons, of whom 749 had COVID-19 diagnoses. Among PLHIV, COVID-19 was more common in migrants, men who have sex with men, and those with ≥4 comorbidities. Severe outcomes were more common among persons aged >75, of non-Spanish origin, and with chronic neuropsychiatric, autoimmune, respiratory, and metabolic comorbidities. Lower CD4 counts were also associated with worse outcomes, although only among those with detectable plasma HIV levels.