Recent studies on HIV and COVID-19 coinfection

Simon Collins, HIV i-Base

The following papers have been published that include clinical outcomes on HIV positive people who were diagnosed with COVID-19, with brief summaries from the abstract.

Impact of HIV on infection and mortality: literature review

A systematic literature review of 68 papers (including 11 prereview) reported that earlier small studies reported little difference between people living with HIV and the general population, larger studies. However, larger studies (from South Africa, the UK and the US) reported a higher risk in multivariate analyses of severe responses including higher mortality (with relative risks from 1.7 to 2.3).

A significant difference included that serious COVID-19 events in people living with HIV were reported at a lower age.

Reference: Macallan D et al. Does HIV impact susceptibility to COVID-19 (SARS-CoV-2) infection and pathology? A review of the current literature. MedRxiv. DOI: 10.1101/2020.12.04.20240218. (7 December 2020).

HIV associated with higher COVID-19 mortality in New York State

A retrospective review based on surveillance data from >108,000 people living with HIV compared to 20 million people in general population with PCR-confirmed COVID-19 from 1 March to 7 June 2020.

The study measured diagnoses, hospitalisation (within 30 days of a positive test) and in-hospital deaths.

Demographics included age, sex and region with CD4, viral load and related information for those living with HIV and adjusted rate ratios (RR) included race and ethnicity.

Overall, 2998 HIV positive people were diagnosed with COVID-19 (27.6 vs 19.4/1,000 in general population) with an unadjusted RR: 1.43; 95%CI: 1.38 to 1.48). This effect was no longer significant though in an adjusted analysis (indirect standardized RR: 0.94; 95%CI: 0.91 to 0.97).

However, hospitalisation rates were significantly higher: 8.29 vs 3.15/1,000; RR after standarisation: 1.38 (95%CI: 1.29 to 1.47), as was in-hospital deaths. There were 207 deaths in HIV positive people with standardised mortality rate 1.23 (95%CI: 1.13 to 1.48).

Amongst HIV positive people, having undetectable viral load on ART was associated with reduced risk of COVID-19 diagnosis: RR 0.70 (95%CI: 0.61 to 0.80).

Reference: Tesoriero J et al. Elevated COVID-19 outcomes among persons living with diagnosed HIV infection in New York State: results from a population-level match of HIV, COVID-19, and hospitalization databases. MedRxiv. DOI: 10.1101/2020.11.04.20226118v1. (6 November 2020).
Note: Since published in JAMA.Network Open, 2021;4(2):e2037069. DOI:10.1001/jamanetworkopen.2020.37069. (3 February 2021).

Lower CD4 count is associated with increased risk of severe COVID-19 in people living with HIV

A retrospective analysis of 175 HIV positive adults with PCR-confirmed COVID-19 from three local cohorts – in Italy (n=65), Spain (n=49) and Germany (n=61) – reported low CD4 counts as an independent risk for more severe COVID-19. The analysis adjusted for all key HIV and COVID-19 factors.

Overall, COVID‐19 was mild‐to‐moderate in 126 (72%) and severe in 49 cases (28%) – of which 16/40 were critically ill. 

Median CD4 count was 663 cells/mm3 (range: 69 to 1715) and 69% had a CD4 count >500 cells/mm3. However, 39% had a  CD4 nadir <200 cells/mm3 and 31% had a previous AIDS‐defining illness.

CD4 count and nadir was lower in participants with severe vs mild to moderate infection: 449 (69 to 1,100) vs 717 (161 to 1,715) and 185 (1 to 650) vs 304 (4 to 1,336) for current and nadir counts respectively.

In multivariate analysis, only current CD4 count <350 cells/mm3 and presence of at least one cormorbidity were significantly associated with severity of COVID-19 with adj. OR 2.85 (95% CI: 1.26 to 6.44), p=0.01, for severe disease.

Although nadir CD4 T‐cell count <200 cells/mm3 was the only factor associated with mortality (OR = 10.11; 95% CI: 1.19 to 86.10; p=0.03), the number of deaths was too low to run an adjusted analysis.

Reference: Hoffmann C et al. Immune deficiency is a risk factor for severe COVID‐19 in people living with HIV. HIV Medicine. (27 December 2020).

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