COVID-19 outcomes in people living with HIV: peering through the waves

Abstract Background: HIV infection remains a public health concern, especially in low- and middle-income countries. Data regarding exposure of COVID-19 in HIV infected patients remains scarce. We evaluated clinical characteristics and outcomes of COVID-19 patients infected with HIV, and compared with a paired sample without HIV infection. Methods: This is a substudy of a large Brazilian cohort that comprised two periods (2020 and 2021). Data was obtained through the retrospective review of medical records to collect variables of interest and primary outcomes: intensive care admission, mechanical ventilation and death. COVID-19 patients infected with HIV were compared to COVID-19 patients without concomitant diagnosis of HIV infection using the Chi-Square Test and Fisher's exact test for categorical variables and the Wilcoxon test for numerical variables. Both groups were matched for age, sex, number of comorbidities and hospital of origin using the technique of propensity score matching (up to 4:1).Results: Throughout the study, 17,101 COVID-19 patients were hospitalized, 130 (0.76%) of these infected with HIV. The median age was 54 (IQR: 43.0;64.0) years in 2020 and 53 (IQR: 46.0;63.5) years in 2021, with predominance of females in both periods. People living with HIV (PLHIV) and their controls showed similar prevalence for the admission in the ICU and mechanical ventilation requirement in the two periods, with no significant differences. In 2020, in-hospital mortality was higher in the PLHIV compared to the controls (27.9% vs 17.7%; p=0.049), but there was no difference in mortality between groups in 2021 (25.0% vs 25.1%; p>0.999). Conclusion: Our results reiterate that PLHIV were at higher risk of COVID-19 mortality in the early stages of the pandemic, however, this finding did not sustain in 2021, indicating that measures such as large-scale immunization programs have successfully contributed to reducing the excess mortality seen in PLHIV.