Unsuppressed plasma HIV-RNA viral load is associated with worse COVID-19 outcomes among people living with HIV

BACKGROUND: Information about the relationship between HIV-associated immune suppression and COVID-19 outcomes is scarce. We characterized the sociodemographic and clinical features, and impact of immunosuppression on COVID-19-related outcomes among persons living with HIV (PLWH).
METHODS: PISCIS is a population-based cohort of PLWH aged '¥16 years in care at 16 Catalan hospitals, which collects sociodemographic and clinical data between 01/01/1998 and 15/12/2020. We linked PISCIS data with the Public Data Analysis for Health Research and Innovation Program of Catalonia (PADRIS) to obtain COVID-19 diagnosis related data and other comorbidities. Only patients with microbiologically confirmed SARS-CoV-2 infection (NAAT, antigen detection or antibodies) were included in the analysis. Factors associated with COVID-19 diagnosis and severe outcomes were assessed using multivariate Cox regression models. We estimated the impact of immunosuppression on severe outcomes (hospital admission or death) using survival analysis.
RESULTS: Of 13,142 PLWH on follow-up, 749 (5.7%) were diagnosed with SARS-CoV-2. Among them, 618/749 (82.5%) were males and the median age was 43.5 years ([IQR] 37.0-52.7). 103 (13.8%) were hospitalized, 7 (0.9%) were admitted to the ICU and 13 (1.7%) died. SARS-CoV-2 diagnosis was more common among migrants (aHR, 1.55 [95% CI, 1.31-1.83]), MSM (aHR, 1.42 [95% CI, 1.09-1.86]) and those with '¥4 comorbidities (aHR, 1.46 [95% CI, 1.09-1.97]). Age '¥75 years (aHR, 5.2 [95%CI:1.8-15.3]), non-Spanish origin (aHR, 2.1 [95%CI:1.3'3.4]) and chronic comorbidities (neuropsychiatric aHR, 1.69 [95% CI, 1.07-2.69], autoimmune disease aHR, 1.92 [95% CI, 1.14-3.23] respiratory disease aHR, 1.84 [95% CI, 1.09-3.09] and metabolic disease aHR, 2.59 [95% CI, 1.59-4.23]) were associated with higher risk of severe outcomes. A Kaplan-Meier estimator showed differences in the risk of severe outcomes according to CD4 levels in patients with detectable HIV viral load (P<.039) but no differences were observed in patients with undetectable HIV viral load (P=.15).
CONCLUSIONS: SARS-CoV-2 diagnosis in PLWH was more common among migrants, those with '¥4 comorbidities and MSM. Among co-infected patients, those with detectable HIV viral load, older age, chronic comorbidities and migrants had higher risks of severe outcomes. Of note, detectable HIV viral load and not CD4 count <200cells/mm³ was a risk factor for severe COVID-19.