People with HIV (PWH) hospitalized with coronavirus disease 2019 (COVID-19) have an increased risk of 28-day mortality, according to data published in Clinical Infectious Diseases.
Investigators compared the characteristics and outcomes of COVID-19 patients with and without HIV using data prospectively captured by the International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) World Health Organization (WHO) Clinical Characterization Protocol study. Of the 47,592 patients in the database, 122 (0.26%) were HIV-positive and 112/122 patients (91.8%) had a record of antiretroviral therapy.
PWH were younger (median age, 56 vs 74 years; P <.001), had fewer overall comorbidities, had lower prevalence of cardiac and pulmonary disease, dementia, and malignancy compared with patients without HIV. Baseline characters showed PWH had higher rates of moderate to severe liver disease (P =.01) and their duration of COVID-19 symptoms were longer (median, 5 vs 3 days; P =.002) compared with patients without HIV. PWH were also more likely to present with symptoms such as headache, fever, myalgia and tachycardia, cough, and chest pain.
After adjusting for demographic factors and comorbidities, results showed that the odds of admission to critical care were similar between HIV-positive and -negative patients (odds ratio, 1.22; 95% CI, 0.80-1.87; P =.35). In PWH, 30% of patients died by day 28, compared with 29.4% of HIV-negative patients; the cumulative incidence of day-28 mortality of 26.7% vs. 32.1%, respectively (P =.16).
However, stratification by age revealed higher mortality in younger PWH. Mortality for patients under 60 years of age was 21.3% in PWH and 9.6% in patients without HIV (adjusted hazards ratio [aHR], 2.87; 95% CI, 1.70-4.86; P <.001). After adjusting for age, mortality remained significantly higher in the HIV group (aHR, 1.47; 95% CI, 1.01-2.14; P =.05).
The study did not investigate risk factors for a COVID-19 diagnosis or hospitalization from the disease among PWH. The study also lacked data to adjust for deprivation or socio-economic status. Overall, the data is limited by a small number of HIV patients and investigators advise caution when interpreting the results.
“After careful considerations, our analysis of the outcomes of patients hospitalized with COVID-19 in the United Kingdom shows an increased risk of day-28 mortality due to HIV-positive status,” investigators concluded.
Geretti AM, Stockdale AJ, Kelly SH, et al. Outcomes of COVID-19 related hospitalization among people with HIV in the ISARIC WHO Clinical Characterization Protocol (UK): a prospective observational study. Clin Infect Dis. Published online October 23, 2020. doi:10.1093/cid/ciaa1605.