Another study adds evidence that HIV may be risk factor for severe COVID-19
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HIV was an independent risk factor for severe COVID-19 at hospital admission and in-hospital mortality in a study that included nearly 200,000 patients from dozens of countries.
Researchers calculated that people with HIV were 15% more likely to present with severe COVID-19 and 38% more likely to die in the hospital compared with people who were HIV-negative.
Bertagnolio S, et al. Lancet HIV. 2022;doi:10.1016/S2352-3018(22)00097-2.
“People living with HIV with advanced disease, those with low CD4 and high viral load and those who are not taking antiretroviral treatment have an increased risk of infections and related complications in general,” WHO’s Silvia Bertagnolio, MD, told Healio. “Until now, evidence accumulated regarding the risk of adverse COVID-19 outcomes in people living with HIV has shown conflicting findings.”
Indeed, as Bertagnolio noted, results from small studies conducted early in the pandemic often provided conflicting evidence — sometimes even in the same location — but a larger analysis conducted by WHO indicated that HIV was an independent risk factor for severe or critical COVID-19, according to results published last summer.
“Broader geographical representation and a larger dataset including individual-level clinical data are required to expand our understanding of how HIV infection impacts clinical outcomes secondary to hospitalization with COVID-19,” Bertagnolio said.
The new study includes anonymous data from 338,566 patients in 38 countries that were reported to WHO between Jan. 1, 2020, and July 1, 2021. Bertagnolio and colleagues used these data to compare outcomes in the two populations and identify risk factors.
Of the 197,479 patients reporting HIV status, 8.6% had HIV, including 91.5% of whom were on ART. Of the patients with HIV, 38.3% were admitted to the hospital with severe illness and 24.3% died while in the hospital.
Bertagnolio and colleagues calculated that people with HIV had a 15% increased odds of severe COVID-19 presentation (adjusted OR = 1.15; 95% CI, 1.10-1.20) and were 38% more likely to die while in the hospital (adjusted HR = 1.38; 95% CI, 1.34-1.41) compared with the patients in the cohort without HIV.
“Although additional subgroup analyses showed an association between individuals using ART or viral load suppression with a reduced risk of poor outcomes, HIV infection itself still remained a risk factor for severity of illness and mortality,” Charles Feldman, MB BCh, PhD, and Jarrod Zamparini, MB BCh, of the University of the Witwatersrand in Johannesburg wrote in an accompanying commentary.
“As has been noted previously, the presence of at least one additional underlying comorbidity was more frequent among people living with HIV compared with people who were HIV negative, which indicates that not only does HIV need to be comprehensively managed with ART to achieve viral suppression, but also prevention and good management of associated comorbid conditions are essential for better COVID-19 outcomes,” they wrote.
Bertagnolio and colleagues determined that being male between the ages of 45 and 75 years and having chronic cardiac disease or hypertension increased the odds of severe COVID-19, whereas being male; being older than 18 years of age; and having diabetes, hypertension, malignancy, tuberculosis or chronic kidney disease increased the risk for in-hospital mortality among patients with HIV.
ART use and viral load suppression were associated with a reduced risk for poor outcomes, although HIV infection remained a risk factor for severity and mortality regardless of ART and viral load suppression status.
“Underlying conditions such as diabetes and hypertension are common among people living with HIV,” Bertagnolio said. “We know that these conditions put people at increased risk of severe disease and death. This stresses the need for people living with HIV to stay as healthy as possible, regularly access and take their ART medications and prevent and manage underlying conditions.”
Bertagnolio said countries should consider including people with HIV as a priority group for COVID-19 vaccination. The NIH recommended this last year.
“This study adds to the growing body of literature on the potential negative impact of HIV infection on COVID-19 infection,” Feldman and Zamparini said. “However, given the continued discordance in findings, prospective studies with long-term follow-up are also warranted to assess the true impact of HIV on COVID-19 severity and outcome.”
References:
Bertagnolio S, et al. Lancet HIV. 2022;doi:10.1016/S2352-3018(22)00097-2.
Feldman C, Zamparini J. Lancet HIV. 2022;doi:10.1016/S2352-3018(22)00132-1.
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