HIV May Increase Risk of Severe COVID-19 Infection

Persons living with HIV may be predisposed to more severe coronavirus disease 2019 (COVID-19) infection compared with those who do not have HIV, reports a study published in JAMA Network Open. Higher rates of hospitalization and death are also likely.

“Persons living with diagnosed HIV infection with a low CD4 cell count or not receiving HIV treatment are currently listed by the [CDC] as possibly at risk for severe illness from COVID-19,” the study authors noted, but just how much that risk is elevated and the actual rates of serious COVID-19–related outcomes remain unknown.

With New York being at the crossroads of the HIV epidemic and the COVID-19 pandemic, a group of researchers wanted to know what, if any, correlation there was between the 2 disease states. “Is there an association between prior diagnosis of HIV infection and [COVID-19] diagnosis, hospitalization, and in-hospital death among residents of New York state?” they asked.

Their retrospective cohort analysis found an overall 6.9% (n = 207) in-hospital mortality rate among all persons living with HIV who were hospitalized (n = 896) through June 15 because of severe cases of COVID-19. This represents elevated rates per population (standardized rate ratio [sRR], 1.23; 95% CI, 1.07-1.40) and among diagnosed individuals (sRR, 1.30; 95% CI, 1.13-1.48). However, it does not mark a mortality jump among those hospitalized (sRR, 0.96; 95% CI, 0.83-1.09).

In addition, after standardization, despite overall similar COVID-19 diagnosis rates vs persons not living with HIV (sRR, 0.94; 95% CI, 0.91-0.97), the investigators saw higher levels of the following among the HIV cohort:

• More hospitalizations, per population (sRR, 1.38; 95% CI, 1.29-1.47) and among diagnosed individuals (sRR, 1.47; 95% CI, 1.37-1.56)
• Elevated COVID-19 diagnoses per 1000 persons vs HIV-negative individuals: 27.7 vs 19.4 (unadjusted rate ratio [RR], 1.43; 95% CI, 1.38-1.48)
• More COVID-19 diagnoses among non-Hispanic Blacks (aRR, 1.59; 95% CI, 1.40-1.81) and Hispanics (aRR, 2.08; 95% CI, 1.83-2.37) vs Whites
• Greater risk of hospitalization with higher-stage HIV compared with stage 1 (>500 cells/mm³):
  • HIV stage 2 (200-499 cells/mm³) had an sRR of 1.29 (95% CI, 1.11-1.49)
  • HIV stage 3 (<200 cells/mm³) had an sRR of 1.69 (95% CI, 1.38-2.07)

Risk of hospitalization remained elevated among the 3 HIV stages when the investigators looked at this outcome relative to persons without diagnosed HIV:

• Stage 1 (sRR, 1.19; 95% CI, 1.08-1.30)
• Stage 2 (sRR, 1.60; 95% CI, 1.42-1.78)
• Stage 3 (sRR, 2.66; 95% CI, 2.20-3.13)

Unadjusted analysis also uncovered the following among individuals living with HIV:

• Higher hospitalization rates if they were:
  • Aged 40 or younger (RR, 3.08; 95% CI, 2.40-3.95)
  • Women (RR, 3.19; 95% CI, 2.82-3.59)
  • Lived in the rest of New York state (RR, 3.51; 95% CI, 2.37-5.20)
• Higher per-population mortality if they were:
  • Aged 40 or younger (RR, 5.74; 95% CI, 2.14-15.42)
  • Women (RR, 3.74; 95% CI, 2.94-4.77)
  • Lived on Long Island (RR, 2.42; 95% CI, 1.40-4.17)

Compared with the same time period in 2019, which saw 490 HIV-related deaths, the 207 COVID-19–related study deaths “represent a 42% addition to anticipated deaths during this same interval in 2020,” the authors noted.

Both the city and the state were included in this cohort study of 2998 patients living with HIV (70.6% men; 80.6% in New York City; mean [SD] age, 54.0 [13.3] years) and diagnosed COVID-19 (2.8% of all persons with diagnosed HIV in the state), which took place between March 1 and June 15, 2020. The investigation incorporated HIV surveillance data from the state HIV surveillance registry, COVID-19 laboratory-confirmed diagnoses data from New York’s Electronic Clinical Laboratory Reporting System, and hospitalization data from the State Health Information Network for NY, with the goal to uncover trends in COVID-19 diagnosis, hospitalization, and in-hospital mortality.

“Because HIV infection is a marker for, and may play a direct role in, more severe COVID-19 outcomes, persons living with diagnosed HIV (with any CD4 count) may warrant recategorization from ‘might be at increased risk’ to ‘increased risk’ in the [CDC]’s underlying medical conditions list,” the authors conclude. “Our findings present an opportunity to address health equity with regard to HIV and COVID-19 through a combination of prevention and treatment approaches.”

Reference

Tesoriero JM, Swain CAE, Pierce JL, et al. COVID-19 outcomes among persons living with or without diagnosed HIV infection in New York state. JAMA Netw Open. Published online February 3, 2021. doi:10.1001/jamanetworkopen.2020.37069