HIV associated with higher risk of severe COVID-19 in US cohort

Simon Collins, HIV i-Base

A US case-control observational study matched HIV positive and HIV negative samples collected from August to September 2020 looked at incidence and severity of COVID-19. [1]

The study, reported in Lancet HIV, included 1138 samples from 955 people living with HIV and 1118 samples from 1062 people without HIV. The analysis adjusted for age, sex, race or ethnicity, and clinical factors (ie, history of cardiovascular or pulmonary disease, and type 2 diabetes).

Baseline characteristics of the HIV positive group included median age of 54 years (IQR: 46 to 63), median CD4 452 cells/mm(IQR: 249 to 656) and 88% with a viral load of ≤200 copies/mL.

Fewer infections were detected in the HIV positive vs negative groups: 3.7% (95% CI: 2.4 to 5.0) vs 7.4% (5.7 to 9.2). The adjusted odds ratio was 0.50 (95% CI: 0.30 to 0.83).

However, the risk of more severe COVID-19 was higher in the HIV positive group (although confidence intervals were wide). In the 31 vs 70 people with evidence of past infection, the odds of severe COVID-19 were 5.5 times higher in the HIV positive group (95% CI: 1.01 to 64.48). In 3/5 HIV postive people with severe COVID-19, the CD4 count was <200 cells/mm3 with OR: 25 to 49 and a very wide confidence interval (95% CI: 1.41 to 1805.02).

IgG concentrations and antibody titres were also lower in the HIV positive group, although avidity was similar.

An accompanying editorial article highlighted the importance of finding lower immune responses to natural infection in the HIV positive group. Even though the numbers are small with no prospective follow-up, the comment suggests that HIV positive people might be at higher risk of reinfection. [2]


  1. Spinelli MA et al. SARS-CoV-2 seroprevalence, and IgG concentration and pseudovirus neutralising antibody titres after infection, compared by HIV status: a matched case-control observational study. Lancet HIV. 2021; doi:10.1016/S2352-3018(21)00072-2. (29 April 2021).
  2. Dauby N et al. SARS-CoV-2 immunity and HIV infection: total recall? Lancet HIV. DOI: 10.1016/S2352-3018(21)00097-7. (29 April 2021).

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