People Living With HIV Appear to Experience More Severe COVID-19 and Increased In-Hospital Mortality
Presenter: Silvia Bertagnolio, MD, World Health Organization, Department of HIV, Hepatitis and STI Programmes, Geneva, Switzerland
Summary of Clinical Characteristics and Prognostic Factors in People Living With HIV Hospitalized With COVID-19: Findings From the WHO Global Clinical Platform from on demand e-poster PE02-B78: COVID-19 Morbidity and Mortality in People Living With HIV
HIV infection is a significant independent risk factor for both severe illness and in-hospital mortality resulting from COVID-19, according to a new global analysis from the World Health Organization (WHO).
These results suggest that people living with HIV (PLWH) should be added to the list of groups prioritized in COVID-19 vaccine rollout efforts.
Previous evidence regarding the impact of HIV infection on the severity of illness and mortality from COVID-19 has been limited and sometimes conflicting, and most analyses have been based on relatively small cohorts of individuals in specific settings. In the new report, WHO researchers analyzed clinical data submitted to WHO Global Clinical Platform for COVID-19 from 24 countries on more than 15,500 PLWH who were hospitalized for COVID-19.
“We found PLWH are more likely to be admitted to the hospital with serious COVID-19 infections, and they have a 30% higher risk of dying in hospital, independent of age, gender, and comorbidities,” said lead author Silvia Bertagnolio, MD, WHO, Department of HIV, Hepatitis and STI Programmes, Geneva, Switzerland. PLWH and comorbidities, who were male or over age 75 were associated with an increased risk of death.
Of WHO data that included 168,649 patients from 37 countries who were hospitalized for COVID-19 between January 2020 and April 2021, 15,522 from 24 countries also had HIV. The median age was 45.5 years, 91.8% of those with HIV were on antiretroviral therapy, and 36.2% had severe/critical illness. Their most common underlying chronic conditions were hypertension (33.2%), diabetes (22.7%), and obesity (16.9%).
Bivariate and regression analyses were conducted to determine whether HIV status was a risk factor for illness severity and in-hospital mortality. The models were adjusted for potential correlation for clustering at the country level.
Among patients with a known outcome, 23% died in hospital. The study team determined that HIV infection was associated with an increased risk of severe or critical COVID-19 presentation (odds ratio 1.13, adjusted for age, sex and comorbidity burden) and increased risk of in-hospital mortality (hazard ratio 1.30, adjusted for age, gender, disease severity, and comorbidities burden).
Adverse COVID-19 outcomes were clearly associated with HIV. “The latest meta-analysis shows a strong association of HIV and mortality,” said Bertagnolio. Many countries with high numbers of PLWH are also showing high rates of COVID-19 cases. About 95% of the PLWH included in the analysis were from sub-Saharan Africa, where two-thirds of HIV cases occur worldwide. “The strength of this analysis is that we report data from the continent where the HIV burden actually is occurring,” said Bertagnolio.
Based on the study results, WHO intends to add HIV infection as a risk factor in its clinical guidelines for COVID-19. The researchers noted that as data contribution expands, the generalizability of these findings is expected to increase and inform clinical management in this co-infected vulnerable population. “It’s important to stress the need for HIV patients to regularly have access to medication,” said Bertagnolio.
“This study underscores the importance of countries including all PLWH in the list of priority populations for national COVID-19 vaccine programs,” said International AIDS Society President and International AIDS Society 2021 Co-Chair Adeeba Kamarulzaman, Associate Professor (Adjunct) of Medicine at the Yale School of Medicine. “The global community must also do much more to bring COVID-19 vaccines to countries around the world with high prevalence of HIV and other diseases. It is unacceptable that as of today, less than 3% of the entire African continent has received a single dose of the vaccine and less than 1.5% have received both doses.”
Disclosures
Silvia Bertagnolio, MD, reported nothing to disclose.
Adeeba Kamarulzaman reported nothing to disclose.
Reference
Ambrosioni J, Blanco JL, Reyes-Uruena JM, et al. Overview of SARS-CoV-2 infection in adults living with HIV. Lancet HIV 2021; 8(5):e294–e305. doi: 10.1016/S2352-3018(21)00070-9
Bertagnolio S, Thwin SS, Silva R, et al. Clinical characteristics and prognostic factors in people living with HIV hospitalized with COVID-19: Findings from the WHO Global Clinical Platform. IAS 2021; July 19, 2021. Abstract 2498.