The WHO analysis also shows a higher risk of hospital mortality.
By Ed Susman
HIV was independently associated with a higher risk of severe or critical COVID-19, according to an analysis by the World Health Organization (WHO).
In a study of people living with HIV in Asia, Europe, Africa, and South America who were also hospitalized for COVID-19, HIV infection was associated with a higher risk of severe or critical COVID-19 presentation, after adjusting for age, sex, and comorbidity burden, reported Silvia Bertagnolio, MD, of the WHO in Geneva, Switzerland.
In addition, HIV infection was linked to a higher risk of in-hospital mortality, he said during a press conference at the virtual meeting of the International AIDS Society (IAS).
"This 30% increase in the risk of dying in the hospital among people living with HIV is independent of age, sex, severity of illness at admission, and comorbidity," Bertagnolio explained.
IAS President Adeeba Kamarulzaman, MBBS, who moderated the press conference, called the in-hospital mortality rate "staggering… this study underscores the importance of countries including all people living with HIV on the list of priority populations for national COVID-19 vaccination programs."
“It is also critical that health systems maintain HIV services during the COVID-19 pandemic, particularly in countries with high HIV prevalence,” emphasized Kamarulzaman, a member of the WHO Scientific Council. “Unfortunately, as we know, sub-Saharan African countries with the highest HIV burden are not receiving much COVID-19 vaccine coverage, and this must change.”
“The global community must also do much more to deliver COVID-19 vaccines to countries around the world with high prevalence of HIV and other diseases,” Kamarulzaman said in a statement. “It is unacceptable that to date, less than 3% of the entire African continent has received a single dose of the vaccine and less than 1.5% has received both doses.”
Bertagnolio said that previous evidence regarding the impact of HIV infection on the severity and mortality of COVID-19 has been limited and sometimes contradictory, and most analyses have been based on relatively small cohorts of people in specific settings.
Their group analyzed patients hospitalized with COVID-19 between January 2020 and April 2021 (n = 168,649; 37 countries) and identified those (n = 15,522; 24/37 countries) who also had HIV. The patients' mean age was approximately 45 years, and 37.1% were male; 91.8% of those with HIV were on antiretroviral therapy. Bivariate and regression analyses were performed to determine whether HIV status was a risk factor for severity at admission and hospital mortality. Models were adjusted to determine potential correlations for clustering at the country level.
At the time of presentation, 36.2% of people with HIV had severe or critical COVID-19 symptoms. Of the patients with a known outcome, 23.1% died from COVID-19, the authors reported. Among patients with HIV infection who died in the hospital, other significant risk factors associated with higher mortality were age > 65 (OR 1.82, 95% CI: 1.62–2.04), male sex (OR 1.21, 95% CI: 1.15–1.28), diabetes (OR 1.50, 95% CI: 1.39–1.62), and hypertension (OR 1.26, 95% CI: 1.19–1.34).
The data for the analysis came from the WHO's Global Clinical Platform for COVID-19. Bertagnolio said that, based on the study's findings, the WHO intends to add HIV infection as a risk factor in its clinical guidelines for COVID-19. She called the data "a living analysis" that will be updated routinely.
Main source
International AIDS Society