Characteristics and outcomes of people living with HIV hospitalised at tertiary healthcare institutions during the COVID-19 pandemic in Mexico City

Abstract

Background: While existing research on people living with HIV (PWH) during the COVID-19 pandemic primarily focused on their clinical outcomes, a critical gap remains in understanding the implications of COVID-19 delivery of in-hospital care services to PWH. Our study aimed to describe the characteristics and outcomes of PWH hospitalised during 2020 in Mexico City, comparing patients admitted due to COVID-19 vs. patients admitted due to other causes.

Methods: All PWH hospitalised for ≥ 24 h at four institutions in Mexico City from January 1st to December 31st, 2020 were included. Patients were classified into two groups according to the leading cause of their first hospitalisation: COVID-19 or non-COVID-19. Characteristics among groups were compared using chi-square and Kruskal tests. A Cox model was used to describe the risk of death after hospitalisation and the characteristics associated with this outcome. Mortality and hospitalisation events were compared to data from 2019.

Results: Overall, we included 238 PWH hospitalised in 2020. Among them, 42 (18%) were hospitalised due to COVID-19 and 196 (82%) due to non-COVID-19 causes, mainly AIDS-defining events (ADE). PWH hospitalised due to COVID-19 had higher CD4 + cell counts (380 cells/mm3 [IQR: 184-580] vs. 97 cells/mm3 [IQR: 34-272], p < 0.01) and a higher proportion of virologic suppression (VS) compared to those hospitalised due to non-COVID-19 causes (92% vs. 55%, p < 0.01). The adjusted hazard ratio (aHR) for AIDS was 3.1 (95%CI: 1.3-7.2). COVID-19 was not associated with death (aHR 0.9 [95%CI: 0.3-2.9]). Compared to 2019, mortality was significantly higher in 2020 (19% vs. 9%, p < 0.01), while hospitalisations decreased by 57%.

Conclusions: PWH with COVID-19 had higher VS and CD4 + cell counts and lower mortality compared to those hospitalised due to non-COVID-19-related causes, who more often were recently diagnosed with HIV and had ADEs. Most hospitalisations and deaths in 2020 in PWH were related to advanced HIV disease. The increased mortality and decreased hospitalisations of PWH during 2020 evidence the impact of the interruption of health services delivery for PWH with advanced disease due to the pandemic. Our findings highlight the challenges faced by PWH during 2020 in a country where advanced HIV remains a concern.

Keywords: AIDS; Hospitalisation; Latin America; México; Observational; SARS-CoV-2.

Fig. 1

Adjusted survival probability since the first hospitalisation for COVID-19 vs. non-COVID-19. Note Adjusted survival from a Cox model for death, stratified by COVID group, including sex, age, COVID group, and the interaction between AIDS diagnosis and HIV diagnosis during hospitalisation. The curves are predicted survival curves using male sex, 40 years old, non-HIV diagnosis and non-AIDS status. The grey area depicts the 95% confidence interval

Fig. 2

Adjusted survival probability since the first hospitalisation for AIDS vs. non-AIDS. Note Adjusted survival from a Cox model for death, stratified by COVID group, including sex, age, COVID group, and the interaction between AIDS diagnosis and HIV diagnosis during hospitalisation. The curves are predicted survival curves using male sex, 40 years old, non-HIV diagnosis during hospitalisation, and no-COVID status. The grey area depicts the 95% confidence interval.