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Predictors of in-hospital mortality in HIV-infected patients with COVID-19
V Moreno-Torres1,2, C de Mendoza1,2, M Martínez-Urbistondo1
1Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 1, Majadahonda 28222, Madrid, Spain.
Insights
Persons with human immunodeficiency virus (HIV) hospitalized with COVID-19 in Spain had better survival rates than HIV-negative individuals, likely due to younger age and fewer comorbidities. Advanced liver disease was a key predictor of mortality in HIV-positive patients.
Area of Science:
- Infectious Diseases
- Immunology
- Public Health
Background:
- Severe COVID-19 is linked to underlying immunodeficiency.
- The prognosis for people with human immunodeficiency virus (HIV) and COVID-19 is debated.
- This study examines COVID-19 outcomes in HIV-positive individuals in Spain before vaccine availability.
Purpose of the Study:
- To assess the mortality rate of HIV-infected patients hospitalized with COVID-19 in Spain.
- To identify major determinants of death in this patient group.
- To compare outcomes between HIV-positive and HIV-negative patients hospitalized with COVID-19.
Main Methods:
- Retrospective analysis of a nationwide public hospital discharge database in Spain for 2020.
- Inclusion of all adult hospitalizations for COVID-19.
- Stratification of data based on HIV status and analysis using ICD-10 codes.
Main Results:
- Out of 117,694 COVID-19 hospitalizations, 234 (0.2%) were HIV-positive.
- HIV-positive patients were younger, more male, and had a higher rate of liver disease but lower in-hospital mortality (9.4% vs. 16%).
- Advanced liver disease (RR: 7.6), older age, and dementia were major predictors of death in HIV-positive patients.
Conclusions:
- HIV-infected patients hospitalized with COVID-19 in Spain during 2020 demonstrated better survival than HIV-negative counterparts.
- Younger age and fewer comorbidities likely contributed to improved survival in people with HIV.
- Advanced liver disease emerged as a significant predictor of mortality among HIV-positive individuals hospitalized with COVID-19.
Background:
Underlying immunodeficiency is associated with severe COVID-19, but the prognosis of persons with human immunodeficiency virus (HIV) (PWH) with COVID-19 is under debate. Aim: assessment of the mortality rate and major determinants of death in HIV-infected patients hospitalized with COVID-19 in Spain before vaccine availability. Design: Retrospective nationwide public database analysis.
Methods:
Nationwide, retrospective, observational analysis of all hospitalizations with COVID-19 during year 2020 in Spain. Stratification was made according to HIV status. The National Registry of Hospital Discharges was used with the ICD-10 coding list.
Results:
A total of 117 694 adults were hospitalized with COVID-19 during 2020. Only 234 (0.2%) were HIV-positives. More than 95% were on antiretroviral therapy. Compared to HIV-negatives, PWH were younger (mean age 53.2 vs. 66.5 years old; P<0.001) and more frequently male (74.8% vs. 56.6%; P<0.001). Most co-morbidities predisposing to severe COVID-19 (diabetes, hypertension, dementia and cardiovascular disease) were more frequent in HIV-negatives. In contrast, the rate of baseline liver disease was over 6-fold higher in PWH (27.4% vs. 4.4%; P<0.001). In-hospital mortality was lower in PWH (9.4% vs. 16%; P=0.004). In multivariate analysis, older age, dementia and especially advanced liver disease (relative risk (RR): 7.6) were the major determinants of death in PWH hospitalized with COVID-19.
Conclusion:
HIV-infected patients hospitalized in Spain with COVID-19 during 2020 had better survival than HIV-negatives, most likely explained by younger age and lower rate of co-morbidities. However, advanced liver disease was a major predictor of death in PWH hospitalized with COVID-19.
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