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Observational Study
. 2025 Nov;26(11):1657-1672.
doi: 10.1111/hiv.70094. Epub 2025 Aug 7.

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

Georg M N Behrens  1 , Lambert Assoumou  2 , Stephane De Wit  3 , Rona MacDonald  4 , Nathalie de Castro  5 , Casper Rokx  6 , Holly Middleditch  7 , Margaret Johnson  8 , Jose Luis Casado  9 , Jose Ramon Arribas  10 , Jose-Ramon Blanco  11 , Carl Fletcher  12 , Caroline Eteve-Pitsaer  13 , Aliou Baldé  2 , Anton Pozniak  14   15   16 , Esteban Martinez  17   18 ; HIV CoCo Study Group
Collaborators, Affiliations
Observational Study

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

Georg M N Behrens et al. HIV Med. 2025 Nov.

Abstract

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.

Keywords: COVID‐19; Europe; HIV infection; comorbidity; risk.

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Conflict of interest statement

Georg M. N. Behrens has received honoraria for lectures and advisory boards from Gilead, ViiV Healthcare, MSD, Janssen, Novartis, EUROIMMUN, Moderna and Pfizer. He received funding for research from Novartis to his institution unrelated to this work. Esteban Martinez has received honoraria for lectures or advisory boards from Gilead, Janssen, MSD and ViiV, and his institution has received research grants from MSD and ViiV. Anton Pozniak has received honoraria for lectures and advisory boards from Gilead, ViiV Healthcare and MSD. Casper Rokx declares honoraria for advisory boards and a research grant for investigator‐initiated studies from Gilead and ViiV Healthcare paid to his institution. All other authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Primary and secondary outcomes of people living with HIV with COVID‐19 versus COVID‐19. Depicted are the crude (blue) and adjusted measures (red) of association (95% confidence interval [CI]) for the composite primary endpoint (critical care admission, palliative discharge, death), critical care admission and mortality. For adjusted factors, see Table 3.
See this image and copyright information in PMC

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