Chronic comorbidities, older age, lower BMI, and active smoking status are associated with severe outcomes in HIV-positive patients with COVID-19 infection. However, the relationship between severe outcomes and COVID-19 infection in this population is no longer significant when adjustments are made for HIV-specific variables. These study results were published in Clinical Infectious Diseases.

Researchers conducted a retrospective cohort study to evaluate risk factors associated with COVID-19 infection and severe outcomes among HIV-positive patients. Severe outcomes included hospitalization, intensive care unit (ICU) admission, and mortality. Data for this analysis were captured from January 2020 to December 2021. The primary outcome was polymerase chain reaction (PCR)- or antigen-confirmed COVID-19 infection; secondary outcomes included 30-day hospitalization, ICU admission, and mortality. Multiple variable logistic regression was used to analyze the relationship between severe COVID-19 outcomes and patient demographics, comorbidities, smoking status, BMI, and insurance type.

The final analysis included 43,173 patients with HIV infection, of whom 6472 tested positive for COVID-19 infection. Patients with vs without COVID-19 infection were more likely to be women (37% vs 35%), active smokers (27% vs 21%), Hispanic (8.5% vs 2.8%), and have higher Charlson comorbidity index (CCI) scores (2.06 vs 1.96). 

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Risk factors for PCR- or antigen-confirmed COVID-19 infection among HIV-positive patients included younger age (18-49 years), Hispanic White and African American ethnicity, higher BMI, residence in the Southern United States, and lack of health insurance.

Further analysis among COVID-19-positive patients was performed to determine factors associated with severe outcomes. For the severe outcomes of 30-day hospitalization, ICU admission, and mortality, risk factors included older age, African American ethnicity, residence in the US South, active smoking status, underweight, higher CCI score, and lack of health insurance.

The researchers then examined risk factors associated with COVID-19 infection and severe outcomes among a subgroup of patients (n=5098) after accounting for HIV-specific variables. They found associations between lower CD4+ count and increased risk for COVID-19 infection and detectable HIV viral load and increased risk for hospitalization. In addition, lower CD4+ count, detectable HIV viral load, and lack of antiretroviral therapy use were associated with increased risk of mortality and ICU admission, regardless of COVID-19 status.

An additional analysis was performed to compare severe COVID-19 outcomes between COVID-19-positive vs COVID-19-negative patients with HIV infection who were enrolled after COVID-19 vaccines became available. Using a cutoff date of January 1, 2020, the researchers found no significant associations between COVID-19 infection and hospitalization (odds ratio [OR], 1.08; 95% CI, 0.98-1.19), ICU admission (OR, 1.05; 95% CI, 0.84-1.30), and mortality (OR, 1.37; 95% CI, 0.99-1.84).   

Limitations of this study include potential misclassification bias due to the use of diagnostic codes for disease categorization, the low number of patients with CD4+ count and HIV viral load data, and the use of data only captured from electronic health records.

“These findings underscore the importance of strengthening access to continuous HIV care amid the challenges posed by the COVID-19 pandemic,” the researchers noted. “[W]ith access to vaccines and evidence-based therapies, the morbidity and mortality of SARS-CoV-2 infection on PWH [people with HIV] can be mitigated,” the researchers concluded.

Disclosure: Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Hanna JJ, Geresu LB, Diaz MI, et al. Risk factors for SARS-COV-2 infection and severe outcomes among people with human immunodeficiency virus: cohort studyOpen Forum Infect Dis. Published online July 24, 2023. doi:10.1093/ofid/ofad400

This article originally appeared on Infectious Disease Advisor