Assessing COVID-19 Outcomes in Persons Living with HIV

A syndemic association between the two infections may have an increasing impact on affected people and communities.

Recent data evaluating the association between the coronavirus disease 2019 (COVID-19) and an HIV diagnosis found that persons living with HIV were more likely to be diagnosed and hospitalized with COVID-19, while also having higher rates of mortality than those without HIV. The study was conducted by investigators from the University of Albany in collaboration with the HIV Center for Clinical and Behavioral Studies.

New York is in a unique position to evaluate and describe crossover of HIV and COVID-19, as it has been an epicenter for both. The state leads the nation in deaths from the ongoing pandemic, while also having the second largest population of people living with HIV in the United States.

Through June of 2020, 2.8% of people living with HIV in New York were diagnosed with COVID-19, this represents a nearly 40% higher level than those without HIV.

The retrospective cohort study evaluated 2,988 persons living with HIV and a confirmed case of COVID-19. The data was collected from HIV surveillance programs like the NYS HIV Surveillance Registry, COVID-19 laboratory-confirmed diagnoses like the NYS Electronic Clinical Laboratory Reporting System (ECLRS), and hospitalization databases like the State Health Information Network for NY, in order to provide a population-level comparison.

Findings from the study demonstrated that of the 2,988 participants diagnosed with both HIV and COVID-19, 896 were hospitalized and 207 died in the hospital. While those living with HIV had similar rates of diagnosis with COVID-19 than those without HIV (sRR, 0.94 [95% CI, 0.91-0.97]), they were hospitalized at higher rates per population (sRR, 1.38 [95% CI, 1.29-1.47]) and had elevated rates of mortality (sRR, 1.30 [95% CI, 1.13-1.48]). The investigators also found that the risk of hospitalization increased with HIV disease progression, with stage 2 and 3 having higher levels than stage 1.

Overall, the data from this study illustrates the evidence that persons living with diagnosed HIV experience poorer COVID-19 related outcomes in comparison to those living without HIV.

“Although the mechanisms underpinning increased risk are not fully understood, the intersection of HIV and COVID-19 has multiple implications,” the authors wrote. “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 Centers for Disease Control and Prevention’s underlying medical conditions list.”