HIV independently associated with more severe COVID-19, WHO finds
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HIV is independently associated with a higher risk for severe or critical COVID-19, according to a WHO analysis of more than 15,000 people living with HIV globally.
It was not the first time researchers uncovered a link between HIV and more serious COVID-19 illness — small studies in New York, South Africa and the United Kingdom also have made the connection — but other studies have found no difference in outcomes between patients with or without HIV.
The WHO analysis was broader, with data from dozens of countries collected over more than a year. Based on the results, which were publicized Thursday ahead of the International AIDS Society (IAS) Conference on HIV Science, the IAS recommended that countries add people with HIV to the list of groups that are prioritized for COVID-19 vaccination — something the NIH has recommended since March.
“The global community must also do much more to bring COVID-19 vaccines to countries around the world with high prevalence of HIV and other diseases,” Adeeba Kamarulzaman, MBBS, FRACP, FASc, said in a statement. “It is unacceptable that as of today, less than 3% of the entire African continent has received a single dose of the vaccine and less than 1.5% have received both doses.”
The WHO analysis also found that underlying conditions common among people with HIV — such as diabetes and hypertension — contribute to a higher mortality risk from COVID-19, highlighting the need for patients to stay healthy, prevent and manage their underlying conditions, and have regular access to ART, said Silvia Bertagnolio, MD, an HIV researcher at WHO.
“Ensuring that those who start ART can remain on it to reduce health risks and complications during COVID-19 is critical,” Bertagnolio told Healio. “This must be classified as an essential service, together with prevention, diagnosis and treatment of comorbidities and coinfections. HIV services should be adapted to make this easier and more efficient during the COVID-19 response. Monitoring all people living with HIV and SARS-CoV-2 infection, especially those with advanced HIV disease or with comorbidities, is also fundamental.”
Bertagnolio and colleagues reviewed data on 168,649 hospitalized patients in 24 countries, including 15,522 with HIV. They analyzed data collected between January 2020 and April 2021 regarding the patients’ demographics, clinical features, HIV status, comorbidities, medications and outcomes.
Among the patients with HIV, the mean age was 45.5 years, and 36.2% experienced severe or critical illness upon admission, with the most common underlying conditions being hypertension (33.2%), diabetes (22.7%), and obesity (16.9%).
The researchers determined that HIV was associated with a higher risk of severe or critical presentation (adjusted OR = 1.13) when adjusted for sex, age and comorbidity burden, and was associated with a higher risk of in-hospital mortality (aHR = 1.3) after adjusting for gender, age, disease severity and burden of comorbidities.
Among people with HIV, being aged older than 65 years (aHR = 1.82), being male (aHR 1.21) and having diabetes (aHR = 1.5) or hypertension (aHR = 1.26) augmented the risk for in-hospital death.
Based on the results, WHO plans to add HIV infection as a risk factor in its clinical guidelines for COVID-19, Bertagnolio said.
“This is a living analysis and will be updated regularly as we continue to receive more data from countries,” Bertagnolio said. “WHO will continue to expand the collection and analysis of clinical data of hospitalized people with HIV through the WHO Global Clinical Platform for COVID-19 and encourage countries and stakeholders to contribute anonymized data to increase generalizability of these findings and inform policies.”
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Bertagnolio S, et al. Abstract 2498. Presented at: International AIDS Society Conference on HIV Science; July 18-21, 2021 (virtual meeting).
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