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. 2025 Aug 7.
doi: 10.1111/hiv.70094. Online ahead of print.

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

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. .

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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References

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