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. 2025 Oct 24;22(1):110.
doi: 10.1186/s12981-025-00759-z.

COVID-19 mortality among people living with HIV/AIDS in Brazil: a multilevel analysis

Tatyellen Natasha da Costa Oliveira  1   2 , Mariana Jorge de Queiroz  3 , Anderson Lineu Siqueira Dos Santos  3 , Cleber Nascimento do Carmo  3 , Geraldo Marcelo Cunha  3 , Iuri da Costa Leite  3 , Antonio Guilherme Pacheco  4
Affiliations

COVID-19 mortality among people living with HIV/AIDS in Brazil: a multilevel analysis

Tatyellen Natasha da Costa Oliveira et al. AIDS Res Ther. .

Abstract

Background: The simultaneous COVID-19 and HIV/AIDS pandemics have created unprecedented challenges, disrupting healthcare for people living with HIV/AIDS (PLWHA) and introducing an additional lethal threat. However, the impact of COVID-19 among PLWHA in Brazil remains unclear. We aimed to investigate the association between HIV infection and COVID-19 mortality in the Brazilian population.

Methods: A multilevel study was conducted using data from the Brazilian Mortality Information System. We examined COVID-19 mortality among individuals with and without mention of HIV on their death certificates from 2020 to 2022. Mixed generalized linear regression models were used, considering the COVID-19 dominant Variant of Concern (VOC) and the vaccine rollout period, adjusted for age group and sex, interaction between HIV and age group, and random effects for federative units.

Results: A total of 4,773,337 deaths were analyzed, including 39,011 among PLWHA. Younger (18-39) and older (80+) PLWHA had higher odds of COVID-19 death, particularly during Delta and Omicron periods. Mortality odds among PLWHA were lower during the vaccination expansion phase but increased during the consolidated phase. Regional disparities were observed, with higher mortality odds in Northern and Northeastern Brazil.

Conclusions: HIV infection was associated with higher COVID-19 mortality in Brazil, particularly in specific age groups and regions. Older adults with HIV had an elevated risk of COVID-19 death across all periods. The vaccine rollout reduced COVID-19 mortality among PLWHA, but the results did not hold over time, as evidenced by the increased odds of death in all age groups following vaccination coverage consolidation in the population.

Keywords: COVID-19; Effect modifier; Epidemiologic; HIV; Mortality; Multilevel analysis; SARS-CoV-2.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Research Ethics Committee of the Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation (ENSP/Fiocruz; number 7.210.374). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Effect of HIV on COVID-19 Mortality in Brazil by Age Group. A COVID-19 mortality odds ratios across dominant variant periods; B COVID-19 mortality odds ratios across vaccination rollout phases. Circles represent adjusted odds ratios (OR), and horizontal lines indicate the corresponding 95% confidence intervals (CI)
See this image and copyright information in PMC

References

    1. Filip R, Gheorghita Puscaselu R, Anchidin-Norocel L, Dimian M, Savage WK. Global challenges to public health care systems during the COVID-19 pandemic: a review of pandemic measures and problems. J Pers Med. 2022;12:1295. - PMC - PubMed
    1. Kumah E, Boakye DS, Boateng R, Agyei E. Advancing the Global Fight Against HIV/Aids: Strategies, Barriers, and the Road to Eradication. Ann Glob Health. 89:83. - PMC - PubMed
    1. Eisinger RW, Lerner AM, Fauci AS. Human immunodeficiency virus/AIDS in the era of coronavirus disease 2019: a juxtaposition of 2 pandemics. J Infect Dis. 2021;224:1455–61. - PMC - PubMed
    1. UNAIDS. Brazil | UNAIDS [Internet]. 2024. https://www.unaids.org/en/regionscountries/countries/brazil. Accessed 9 Mar 2025
    1. Grinsztejn B, Luz PM, Pacheco AG, Santos DVG, Velasque L, Moreira RI et al. Changing mortality profile among HIV-infected patients in Rio de Janeiro, Brazil: shifting from AIDS to non-AIDS related conditions in the HAART era. Yazdanpanah Y, organizador. PLoS ONE. 2013;8:e59768. - PMC - PubMed

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