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Multicenter Study
. 2021 May;22(5):372-378.
doi: 10.1111/hiv.13037. Epub 2020 Dec 27.

Immune deficiency is a risk factor for severe COVID-19 in people living with HIV

Christian Hoffmann  1   2 , José L Casado  3 , Georg Härter  4 , Pilar Vizcarra  3 , Ana Moreno  3 , Dario Cattaneo  5   6 , Paola Meraviglia  7 , Christoph D Spinner  8 , Farhad Schabaz  9 , Stephan Grunwald  10 , Cristina Gervasoni  5   7
Affiliations
Free article
Multicenter Study

Immune deficiency is a risk factor for severe COVID-19 in people living with HIV

Christian Hoffmann et al. HIV Med. 2021 May.
Free article

Abstract

Objectives: A prior T cell depletion induced by HIV infection may carry deleterious consequences in the current COVID-19 pandemic. Clinical data on patients co-infected with HIV and SARS-CoV-2 are still scarce.

Methods: This multicentre cohort study evaluated risk factors for morbidity and mortality of COVID-19 in people living with HIV (PLWH), infected with SARS-CoV-2 in three countries in different clinical settings. COVID-19 was clinically classified as to be mild-to-moderate or severe.

Results: Of 175 patients, 49 (28%) had severe COVID-19 and 7 (4%) patients died. Almost all patients were on antiretroviral therapy (ART) and in 94%, HIV RNA was below 50 copies/mL prior to COVID-19 diagnosis. In the univariate analysis, an age 50 years or older, a CD4+ T cell nadir of < 200/µl, current CD4+ T cells < 350/µl and the presence of at least one comorbidity were significantly associated with severity of COVID-19. No significant association was found for gender, ethnicity, obesity, a detectable HIV RNA, a prior AIDS-defining illness, or tenofovir (which was mainly given as alafenamide) or protease inhibitor use in the current ART. In a multivariate analysis, the only factor associated with risk for severe COVID-19 was a current CD4+ T cell count of < 350/µl (adjusted odds ratio 2.85, 95% confidence interval 1.26-6.44, p=0.01). The only factor associated with mortality was a low CD4 T cell nadir.

Conclusions: In PLWH, immune deficiency is a possible risk factor for severe COVID-19, even in the setting of virological suppression. There is no evidence for a protective effect of PIs or tenofovir alafenamide.

Keywords: COVID-19; HIV infection; SARS-CoV-2; antiretroviral therapy; immune deficiency.

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