HIV Infection Increases Risk for Severe COVID-19, COVID-19-Related Mortality

debunking the patient zero theory of AIDS
Study authors evaluated the association between HIV diagnosis and COVID-19 diagnosis, hospitalization, and in-hospital death in New York State.

Persons living with HIV were at increased risk for COVID-19 hospitalization and mortality, according to findings from a retrospective cohort study published in JAMA Network Open.

Data from individuals who tested positive for SARS-CoV-2 in New York state (NYS) were sourced through the NYS HIV surveillance registry, the NYS Electronic Clinical Laboratory Reporting System and the State Health Information Network for NY. Details of COVID-19 severity, hospitalization, and mortality were compared between individuals with and without HIV.

A total of 108,062 individuals were living with HIV in NYS. They were majority men (70.6%) with an average age of 54 years living in New York City (80.6%).

The rate of COVID-19 diagnosis among the general population was 19.4 per 1000 persons and among those living with HIV the rate of diagnosis was 27.7 per 1000 persons (rate ratio [RR], 1.43; 95% CI, 1.38-1.48). Rates of COVID-19 hospitalizations were 3.15 per 1000 persons among the general population and 8.29 per 1000 persons among those with HIV (RR, 2.61; 95% CI, 2.45-2.79). Mortality from COVID-19 occurred at a rate of 0.75 per 1000 among the general population and 1.92 per 1000 among those with HIV (RR, 2.55; 95% CI, 2.22-2.93).

Compared between groups, individuals with HIV were at increased risk for hospitalization if they were less than 40 years of age (RR, 3.08; 95% CI, 2.40-3.95), women (RR, 3.19; 95% CI, 2.82-3.59), and not living in New York City (RR, 3.51; 95% CI, 2.37-5.20). Similarly, persons with HIV who were aged less than 40 years (RR, 5.74; 95% CI, 2.14-15.42), women (RR, 3.74; 95% CI, 2.94-4.77), and living on Long Island (RR, 2.42; 95% CI, 1.40-4.17) were at increased risk for COVID-19-related mortality.

Stratified by HIV stage, compared with the general population, individuals with HIV stage 1 had the lowest risk for COVID-19 hospitalization (standardized RR [sRR], 1.19; 95% CI, 1.08-1.30) than those with stage 2 (sRR, 1.60; 95% CI, 1.42-1.78) or stage 3 (sRR, 2.66; 95% CI, 2.20-3.13).

This study was limited by only including laboratory-confirmed COVID-19 cases which were estimated to only encompass 9% of total infections.

These data suggested coinfection with HIV and COVID-19 increased risk for severe clinical outcomes and death. On the basis of these findings, the Centers for Disease Control and Prevention should add HIV positivity to the list of vulnerable populations and these individuals should be prioritized in vaccination campaigns.


Tesoriero JM, Swain CAE, Pierce JL, et al. COVID-19 outcomes among persons living with or without diagnosed HIV infection in New York State. JAMA Netw Open. 2021;4(2):e2037069. doi:10.1001/jamanetworkopen.2020.37069.