People with HIV did not see large decline in COVID-19 mortality during omicron wave
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Key takeaways:
- People with HIV had a higher risk for death during the pre-delta, delta and omicron waves of SARS-CoV-2.
- In fact, they did not see a large decrease in mortality during the omicron wave, as other groups did.
Compared with their peers, people with HIV experienced a smaller decline in mortality risk from COVID-19 during the omicron wave of the pandemic, researchers reported.
“This study is the third in a series of analyses conducted from individual-level data shared with WHO [beginning] at the start of the COVID pandemic,” Meg Doherty, MD, PhD, director of WHO’s Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programs, said during a press conference ahead of the International AIDS Society conference.
Previous studies have identified HIV infection as a risk factor for severe COVID-19, and people with HIV as a population that should be prioritized for vaccination.
Studies have also shown that the overall mortality risk for patients hospitalized with COVID-19 decreased during the omicron wave.
For this study, Doherty and colleagues assessed the risk for mortality among children and adults coinfected with HIV and SARS-CoV-2 by analyzing individual-level data from the WHO Global Clinical Platform, which included 821,331 hospitalized patients from 42 countries.
They used modeling to evaluate the association between coinfection and in-hospital mortality during the pre-delta, delta and omicron variant waves and to assess risk factors for mortality among people with HIV.
Overall, the study demonstrated that the risk for death among people coinfected with HIV and SARS-CoV-2 was 54% higher during the pre-delta wave (adjusted HR = 1.54; 95% CI, 1.42-1.68), 56% higher during delta wave (aHR = 1.56; 95% CI, 1.4-1.74) and 142% higher during the omicron wave (aHR = 2.42; 95% CI, 2.11-2.78) compared with people who were HIV negative.
People with HIV who received at least one dose of COVID-19 vaccine had a 39% lower risk for death (aHR = 0.61; 95% CI, 0.4-0.92) during the delta wave and 38% (aHR = 0.62; 95% CI, 0.45-0.85) lower risk for death during the omicron wave compared with those who were unvaccinated. The researchers found that the risk for death was highest among people with HIV who had CD4 counts of 200 cells/mm3 or less.
Additional data showed that the mortality rate among people with HIV declined “modestly” — from 25% during the delta wave to 18% during omicron — whereas the mortality rate among people without HIV declined from 21% during delta to 7.9% during omicron. The reduction in mortality was “even less apparent” among those who had CD4 counts of less than 200 cells/mm3.
“Overall, these findings help highlight the need for implementing WHO guidelines for testing and treatment for HIV at every opportunity and providing a booster vaccine for populations most at risk for severe COVID-19 outcomes, including people living with HIV,” Doherty said.
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Bertagnoli S, et al. Abstract 5988. Presented at: International AIDS Society Conference on HIV Science; July 23-26, 2023; Brisbane, Australia.
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