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COVID-19 Severity in People With HIV Compared With Those Without HIV

Vu-Thuy Nguyen1, Kshema Nagavedu1, Monica Morrison2

  • 1Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA.

Journal of Acquired Immune Deficiency Syndromes (1999)
|February 1, 2024
PubMed

Insights

People with HIV (PWH) face similar COVID-19 severity and hospitalization risks as those without HIV overall. However, PWH with low CD4 counts experienced worse outcomes, while those with high counts showed better or similar hospitalization rates.

Area of Science:

  • Infectious Diseases
  • Immunology
  • Public Health

Background:

  • People with HIV (PWH) may be at increased risk for severe COVID-19.
  • Understanding COVID-19 outcomes in PWH is crucial for public health strategies.

Purpose of the Study:

  • To compare the risk of severe COVID-19 outcomes in PWH versus matched individuals without HIV.
  • To investigate the impact of CD4 T-cell counts on COVID-19 severity in PWH.

Main Methods:

  • Retrospective cohort study of adults with SARS-CoV-2 in Massachusetts (March 2020-July 2022).
  • Used electronic medical record data from three large clinical practice groups.
  • Propensity score matching (20:1) to compare outcomes between PWH and individuals without HIV, including severe COVID-19, hospitalization, and length of stay.

Main Results:

  • A total of 171,058 individuals with COVID-19 were identified; 768 PWH were matched with 15,360 individuals without HIV.
  • Overall severe COVID-19 and hospitalization rates were similar between PWH and controls.
  • PWH with low CD4 T-cell counts (<200 cells/mm³) had significantly higher odds of severe COVID-19 and hospitalization (ORs 3.99 and 2.26, respectively).
  • PWH with high CD4 counts showed lower odds of hospitalization (OR 0.73).

Conclusions:

  • PWH with low CD4 T-cell counts experienced worse COVID-19 outcomes.
  • PWH with high CD4 counts had similar or better hospitalization outcomes compared to those without HIV.
  • Generalizability to healthcare settings with less PWH access and engagement requires further investigation.
Abstract

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