Clinical characteristics and prognostic factors in people living with HIV hospitalized with COVID-19: findings from the WHO Global Clinical Platform


BACKGROUND: Published literature on clinical outcomes and prognostic factors in SARS-CoV-2 infection in people living with HIV (PLHIV) remains inconclusive. The World Health Organization has established a Global Clinical Platform aimed to assess clinical features, outcomes and risk factors among individuals hospitalized with suspected/confirmed COVID-19 around the globe.
METHODS: Between January 2020-April 2021 anonymized individual-level clinical data from 268 412 hospitalized patients were reported to the WHO Platform from a mix of sentinel health facilities and national health registries worldwide. Reported standardized set of variables included demographics, clinical features, HIV status, medications, comorbidities and outcomes. Bivariate and regression analyses were conducted to determine whether HIV status was a risk factors for severity at admission and in-hospital mortality. The models were adjusted for potential correlation for clustering at the country level.
RESULTS: Data from 15522 PLHIV out of 168 649 hospitalized individuals were reported from 24 countries. Among PLHIV, 37.1% were male, mean age was 45.5 years, 91.8% received ART and 36.2% had severe/critical illness. Most common underlying conditions were hypertension (33.2%), diabetes (22.7%), obesity (16.9%). 23.1% of PLHIV with a known outcome died in hospital. HIV infection was associated with an increased risk of severe/critical presentation (aOR 1.13), after adjusting for age, sex, comorbidity burden, and of in-hospital mortality (aHR 1.30), after adjusting by age, gender, disease severity and comorbidities burden. Among PLHIV, being >65 years (aHR 1.82), male (aHR 1.21), having diabetes (aHR 1.50) or hypertension (aHR 1.26) increased the risk of in-hospital death.

CONCLUSIONS: Individual clinical data from 37 countries reported to the WHO Global Clinical Platform for COVID-19 indicate that HIV infection is a significant independent risk factor for both severe illness at hospital admission and in-hospital mortality. As data contribution expands, the generalizability of these findings are expected to increase and inform clinical management in this co-infected vulnerable population.