Impact of HIV on COVID-19 outcomes among hospitalized adults in the United States


BACKGROUND: Whether HIV infection is associated with differences in clinical outcomes among people hospitalized with COVID-19 is uncertain. Therefore, the objective of this study was to evaluate the impact of HIV infection on COVID-19 outcomes among hospitalized patients.
METHODS: This cohort study included all adults hospitalized with COVID-19 from March-December 2020 at 107 hospitals in the US participating in the American Heart Association's COVID-19 Cardiovascular Disease Registry. The primary exposure was HIV status, and the primary outcome was in-hospital mortality. We used hierarchical mixed effects models to assess the association of HIV with in-hospital mortality accounting for patient demographics and comorbidities and clustering by hospital. Secondary outcomes included major adverse cardiac events (MACE), severity of illness, and length of stay (LOS).
RESULTS: The registry included 21,528 hospitalization records of people with confirmed COVID-19 from 107 hospitals in 2020, including 220 people living with HIV (PLWH). PLWH were younger (56.0+/-13.0 versus 61.3+/-17.9 years old) and more likely to be male (72.3% vs 52.7%), Non-Hispanic Black (51.4% vs 25.4%), on Medicaid (44.5% vs 24.5), and active tobacco users (12.7% versus 6.5%).

Of the study population, 36 PLWH (16.4%) had in-hospital mortality compared with 3,290 (15.4%) without HIV (unadjusted Risk ratio 1.06, 95%CI 0.79-1.43; risk difference 0.9%, 95%CI -4.2 to 6.1%; p=0.71). After adjustment for age, sex, race, and insurance, HIV was not associated with in-hospital mortality (aOR 1.13, 95%CI 0.77-1.6; p 0.54) even after adding body mass index and comorbidities (aOR 1.15, 95%CI 0.78-1.70; p=0.48). HIV was not associated with MACE (aOR 0.99, 95%CI 0.69-1.44; p=0.91), severity of illness (aOR 0.96, 95%CI 0.62-1.50; p=0.86), or LOS (aOR 1.03, 95% CI 0.76-1.66, p=0.21) among adults hospitalized with COVID-19.

CONCLUSIONS: In this registry-based study of over 21,000 people hospitalized for COVID-19, HIV was not associated with adverse outcomes including in-hospital mortality, MACE, or severity of illness.