Understanding the spectrum of COVID-19 in people with HIV (PWH) is critical to provide clinical guidance and risk-reduction strategies.
CNICS, a U.S. multisite clinical cohort of PWH in care.
We identified COVID-19 cases and severity (hospitalization, intensive care, death) in a large, diverse HIV cohort during March 1-December 31, 2020. We determined predictors and relative risks of hospitalization among PWH with COVID-19, adjusted for disease risk scores.
Of 16,056 PWH in care, 649 were diagnosed with COVID-19 between March-December 2020. Case fatality was 2%; 106 (16.3%) were hospitalized and 12 died. PWH with current CD4 count<350 cells/mm3 (aRR 2.68; 95%CI 1.93-3.71;P<.001) or lowest recorded CD4 count <200 (aRR 1.67; 95%CI 1.18-2.36;P<.005) had greater risks of hospitalization. HIV viral load and antiretroviral therapy (ART) status were not associated with hospitalization, although the majority of PWH were suppressed (86%). Black PWH were 51% more likely to be hospitalized with COVID-19 compared to other racial/ethnic groups (aRR 1.51; 95%CI 1.04-2.19;P=.03). Chronic kidney disease (CKD), chronic obstructive pulmonary disease, diabetes, hypertension, obesity, and increased cardiovascular and hepatic fibrosis risk scores were associated with higher hospitalization risk. PWH who were older, not on ART, with current CD4<350, diabetes, and CKD were overrepresented amongst PWH who required intubation or died.
PWH with CD4<350 cells/mm3, and history of CD4<200, have a clear excess risk of severe COVID-19, accounting for comorbidities associated with severe outcomes. PWH with these risk factors should be prioritized for COVID-19 vaccination, early treatment, and monitored closely for worsening illness.