People with HIV at higher risk for poorer COVID-19 outcomes, study finds
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People living with HIV experienced poorer COVID-19 outcomes than those without HIV, according to findings from a cohort study of New York State residents published in JAMA Network Open.
“These data seem to indicate that people living with an HIV diagnosis are more likely to develop severe complications that require hospitalization,” Eli Rosenberg, PhD, associate professor of epidemiology and biostatistics at the University at Albany School of Public Health, told Healio. “We found that increased likelihood of severe disease unfortunately continued onward toward an increased risk of death.”
Rosenberg and colleagues assessed the outcomes of 2,988 people with HIV who were diagnosed with COVID-19 between March 1 and June 15 last year. The average patient age was 54 years.
People with HIV were hospitalized at a higher rate than those without HIV per population (sRR = 1.38; 95% CI, 1.29-1.47). Additionally, mortality was higher among people with HIV per population (sRR = 1.23; 95% CI, 1.07-1.4) but not among hospitalized patients (sRR = 0.96; 95% CI, 0.83-1.09).
Previous studies have differed in their conclusions regarding the risks for people with HIV and COVID-19. A study conducted in New York City showed that COVID-19 outcomes were not worse among people with HIV, whereas studies in the United Kingdom and South Africa suggested that people with HIV were at increased risk for death. Rosenberg said the difference in outcomes is likely due to the selection of patients who are already hospitalized as study participants.
“Once you are in the hospital, whether you have or don't have HIV, the level of mortality appears to be the same or comparable,” he said. “We replicated that. The difference is in the likelihood of needing to go to the hospital to begin with. If you are beginning a study at the point of hospitalization, you're already a bit too far down the pathway.”
Rosenberg also said that people with HIV should be categorized as an at-risk population for COVID-19 vaccination, and that his study’s results “hammer home” their need for vaccine access.
“The increased mortality risk is there, it's just a matter of finding what explains it,” he said. “We need more in-depth studies to find that, and those studies are harder to do and take more time.”
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