Admission diagnoses and outcomes among hospitalized people living with HIV during pre-COVID-19, COVID-19 and post-COVID-19 pandemic periods

Abstract

Background: Data on the impact of coronavirus disease 2019 (COVID-19) on hospitalization and outcomes among people living with HIV (PLHIV) are limited.

Methods: A retrospective cohort study was conducted among PLHIV hospitalized during the pre-COVID-19, COVID-19, and post-COVID-19 periods.

Results: Of the 310 PLHIV included, 117, 125 and 68 were admitted during the three periods, respectively and 115 (37%) were newly diagnosed with HIV. Median CD4 cell counts and proportions of those with antiretroviral therapy (ART) adherence rates ≥95% at admission were different between the three periods [(206, 97 and 138 cells/mm³ (p = .02) and 97%, 89% and 100% (p = .06), respectively]. Of the 310 PLHIV, admission diagnoses were non-AIDS-related (62%) and AIDS-related (38%). Most of the non-AIDS-related diagnoses were infections other than opportunistic infections (OIs) (40%) while OIs were the most common for AIDS-related diagnoses (88%). The types of admission diagnoses were comparable between the three periods. Hospital mortality rates were 10%, 13% and 16% during pre-COVID-19, COVID-19 and post-COVID-19 periods, respectively (p = .80). By multivariable analysis, intensive care unit admission, underlying malignancy, monthly income less than $USD 400, and admission CD4 less than 50 cells/mm³ were independently associated with hospital mortality.

Conclusions: Although admission during COVID-19 pandemic period was not associated with increased mortality, we observed the impact of the pandemic on the lower CD4 cell count and ART adherence at admission among hospitalized PLHIV. Interventions to improve early care engagement, ART adherence, and close monitoring for those with identified mortality risks are needed for better HIV care, especially during pandemics.

Keywords: COVID-19; Hospitalized; Thailand; human immunodeficiency virus; pandemic; people living with HIV.