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COVID-19 mortality among people living with HIV/AIDS in Brazil: a multilevel analysis

Tatyellen Natasha da Costa Oliveira1,2, Mariana Jorge de Queiroz3, Anderson Lineu Siqueira Dos Santos3

  • 1Escola Nacional de Saúde Pública/ENSP, 1480 Rua Leopoldo Bulhões, Manguinhos, Rio de Janeiro, RJ, 21041-210, Brazil. natashacostah@outlook.com.

AIDS Research and Therapy
|October 24, 2025
PubMed

Insights

People with HIV/AIDS (PLWHA) in Brazil faced higher COVID-19 mortality, especially younger and older adults. While vaccines initially reduced risk, this benefit waned over time, highlighting ongoing disparities.

Area of Science:

  • Public Health
  • Infectious Diseases
  • Epidemiology

Background:

  • The COVID-19 pandemic exacerbated challenges for people with HIV/AIDS (PLWHA), increasing their vulnerability.
  • The specific impact of COVID-19 on PLWHA in Brazil was not well understood, necessitating further investigation.

Purpose of the Study:

  • To examine the association between HIV infection and COVID-19 mortality within the Brazilian population.
  • To identify demographic and temporal factors influencing COVID-19 mortality among PLWHA in Brazil.

Main Methods:

  • A multilevel study analyzed COVID-19 mortality data from the Brazilian Mortality Information System (2020-2022).
  • Mixed generalized linear regression models were employed, accounting for COVID-19 variants, vaccine rollout, age, sex, and regional effects.

Main Results:

  • HIV infection was linked to increased COVID-19 mortality, particularly in younger (18-39) and older (80+) PLWHA, especially during Delta and Omicron variant periods.
  • Mortality odds for PLWHA decreased during vaccine rollout but rose post-vaccination consolidation.
  • Significant regional disparities in mortality odds were observed, with higher risks in Northern and Northeastern Brazil.

Conclusions:

  • HIV infection is a significant risk factor for COVID-19 mortality in Brazil, with notable variations across age groups and regions.
  • Older adults with HIV faced elevated COVID-19 death risks throughout the study period.
  • Vaccination initially mitigated COVID-19 mortality in PLWHA, but this protective effect diminished over time, indicating persistent vulnerabilities.
Abstract

Keywords:
COVID-19Effect modifierEpidemiologicHIVMortalityMultilevel analysisSARS-CoV-2

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