Morbidity and risk factors of COVID-19 in people with HIV-1 in Europe: A combined observational cohort and nested case-control study.

OBJECTIVE

To study the COVID-19 disease course in people living with HIV (PLWH) based on meaningful case numbers, information about comorbidities, antiretroviral and COVID-19 treatment and HIV disease-related variables.

METHODS

Multi-centre, observational, retrospective study of people living with HIV with COVID-19 matched to HIV-uninfected individuals with COVID-19 (HUC) and a case-control study of people living with HIV with COVID-19 matched to COVID-19 negative people living with HIV. Kaplan-Meier estimates and Cox proportional-hazards models stratified on each matched pair were used for COVID-19 outcomes, and conditional logistic regression models were used to identify risk factors for COVID-19 infection.

RESULTS

Five hundred people living with HIV and COVID-19, 1106 HUC and 992 people living with HIV without COVID-19 were included. Rates for chronic kidney disease, peripheral vascular disease, dementia, prior pneumonia and liver disease in people living with HIV with COVID-19 were significantly higher by 4.1-, 2.9-, 2.6-, 2.4- and 1.6-fold, respectively, compared to HIV seronegative COVID-19 patients. Chronic kidney disease, chronic obstructive pulmonary disease (COPD), body mass index (BMI) ≥30 kg/m2, Centers for Disease Control and Prevention stage B versus A and HIV viral load ≥50 copies/mL were significant risk factors for COVID-19 in people living with HIV. Critical care admission or death in people living with HIV was comparable to HUC, whilst people living with HIV stayed longer in hospital (11 vs. 9 days) and in intensive care unit (ICU) (18 vs. 7 days) and had a higher age-adjusted Charlson comorbidity index.

CONCLUSIONS

Our study highlights the importance of a well-controlled HIV infection to prevent severe COVID-19-related outcomes. In people living with HIV and COVID-19, chronic kidney disease and a higher Charlson comorbidity index are risk factors that should prompt early treatment of COVID-19.