BACKGROUND
People with HIV (PWH) may be at risk for more severe COVID-19 outcomes. We compared risk for severe COVID-19 in PWH to matched individuals without HIV.
METHODS
We identified adults in Massachusetts with a positive SARS-CoV-2 test, March 2020-July 2022, using electronic medical record data from three large clinical practice groups. We then used regression models to compare outcomes among PWH versus propensity score-matched people without HIV (matched 20:1) for severe COVID-19 (pneumonia or acute respiratory distress syndrome), hospitalization, and hospital length-of-stay (LOS).
RESULTS
We identified 171,058 individuals with COVID-19; among them, 768 PWH were matched to 15,360 individuals without HIV. Overall, severe COVID-19 and hospitalization was similar in PWH and those without HIV (severe COVID-19: 3.8% vs 3.0%, adjusted OR 1.27, 95% CI 0.86-1.87; hospitalization:12.1% vs 11.3%, adjusted OR 1.08, 95% CI 0.87-1.35). Compared to people without HIV, PWH with low CD4 T-cell counts (<200 cells/mm3) had more severe COVID-19 (adjusted OR 3.99, 95% CI 2.06-7.74 ) and hospitalization (adjusted OR 2.26, 95% CI 1.35-3.80 -), but PWH with high CD4 counts had lower odds of hospitalization (adjusted OR 0.73, 95% CI 0.52-1.03).
CONCLUSIONS
PWH with low CD4 T-cell counts had worse COVID-19 outcomes compared to people without HIV, but outcomes for those with high CD4 counts were similar to, or better than, those without HIV. It is unclear whether these findings are generalizable to settings where PWH have less access to and engagement with healthcare.