HIV infection was found to not be a risk factor for moderate or severe COVID-19 disease or COVID-19 mortality, according to results of a retrospective study published in the Journal of Infection.
Investigators prospectively collected data on all adult patients with known HIV status and COVID-19 admitted to an academic hospital in South Africa between March and September 2020. Data included demographic information, comorbidities, results of laboratory tests performed within 24 hours of initial hospitalization, complications during hospitalization, and mortality. The investigators assessed patients’ illness severity using the CURB-65 (confusion, blood urea >42.8 mg/dL, respiratory rate >30/min, blood pressure <90/60 mm Hg, and age >65 y), national early warning score 2 (NEWS2), and the ISARIC Coronavirus Clinical Characterization Consortium (4C) mortality scores. SARS-CoV-2 infection was confirmed by reverse transcriptase-polymerase chain reaction testing. For patients with known HIV infection, the investigators used viral load and CD4 cell counts obtained within the 6 months prior to hospital admission. An HIV viral load of less than 20 copies/mL was considered viral suppression.
There were 108 patients with HIV infection and 276 without HIV infection included in the study. The majority of patients were Black men, and the median age was 50 years.
The overall mortality in the cohort was 18%, with no significant difference in mortality between patients with vs those without HIV infection (15% vs 20%; P =.31); mortality among those with HIV infection was not associated with age or sex. Length of hospitalization, oxygen saturation, most laboratory results, number of admissions to the intensive care unit, and the need for respiratory support also did not differ significantly between the groups.
There were also no differences in CURB-65, NEWS2, or 4C scores between the groups; however, among patients with HIV infection, a significant difference in NEWS2 (P =.0003) scores was noted between those who lived vs those who died.
Patients with HIV infection were significantly younger compared with those without HIV infection (P =.01). No significant difference in mean age of death from COVID-19 was noted among patients with HIV infection vs those without HIV infection (47.5 vs 57 years, respectively; P =.06).
In patients with HIV infection, diabetes and obesity were associated with increased mortality, and there was a significantly increased incidence of neuropsychiatric disease (P =.04) and active smoker status (P =.04). In addition, hemoglobin, sodium, and albumin concentrations were significantly decreased, and serum urea, alkaline phosphatase, and procalcitonin concentrations were significantly increased. Although mortality rates were decreased in patients with HIV infection with a suppressed viral load vs those without a suppressed viral load, the difference was not significant.
The incidence of obesity was significantly increased among patients without HIV infection (P =.05).
The study was limited by being performed at a single center. In addition, there was a lack of accurate data on duration of antiretroviral therapy, time since HIV diagnosis, and lowest recorded CD4 cell counts, and the cases and controls were not matched for comparison.
The investigators concluded that “the NEWS2 score was a useful predictor of mortality” for patients with both HIV infection and COVID-19.
Venturas J, Zamparini J, Shaddock E, et al. Comparison of outcomes in HIV-positive and HIV-negative patients with COVID-19. J Infect. 2021;83(2):217-227. doi:10.1016/j.jinf.2021.05.020