Risk Factors for Hospitalization in People With HIV and COVID-19

Background: There is conflicting evidence on how HIV influences COVID19 infection. Aim of this study was to compare characteristics at presentation and clinical outcomes of people living with HIV (PLWH) versus HIV negative patients (non-PLWH) hospitalized with COVID-19. Methods: Patients ≥18 years with SARS-CoV-2 infection, defined as positive RT-PCR from nasal/oropharyngeal swab or positive serology, admitted at L. Spallanzani Institute (Italy) were included. Primary endpoint: time to invasive ventilation/death. Secondary endpoints: time to ventilation/death, time to symptoms resolution (resolution of fever or waning from oxygen). In order to control for measured confounders, Cox regression model was used. Results: A total of 905 hospitalized patients were included in the analysis (22 [2.4%] PLWH, 883 non-PLWH): 65% males, 66% with at least one comorbidity, median PaO2/FiO2 at admission 343 mmHg (260-405). PLWH were slightly younger (56 vs 62 years, p=0.057), less likely with pneumonia (59% vs 87%, p<0.001) and with PaO2/FiO2 <300 mmHg at admission (10% vs 31%, p=0.088), with less alterations in lymphocytes (1505 cells/mm vs 1170, p=0.025) and D-dimer (473 ng/mL vs 661, p=0.015) compared with non-PLWH. Symptoms at presentation were similar in the two groups apart from headache and myalgia that were more frequent in PLWH (both p<0.001). Among PLWH, nadir CD4 was 80 (33-284) cells/μl, CD4 at COVID19 diagnosis 350 cells/μl (138-515), all of them were on antiretroviral therapy and 94% had HIV-1 RNA < 50 copies/mL. The cumulative probability of invasive ventilation/death at day 14 was 9.1% (95% CI 2.4-31.7) in PLWH versus 14.7% (12.3-17.6) in non-PLWH (p=0.492). The cumulative probability of non-invasive or invasive ventilation/ death at day 14 was 14.3% (4.8-38.0) in PLWH versus 24.4% (21.4-27.8) in non-PLWH (p=0.372). Following adjustment for age, gender, comorbidities, PaO2/FiO2 and pneumonia at admission, adjusted hazard ratio (aHR) of mechanical ventilation/death of PLWH was 0.95 (95% CI 0.13-6.98, p=0.958) versus non-PLWH;similarly, aHR of non-invasive or invasive ventilation/death of PLWH was 1.05 (95% CI 0.26-4.28, p=0.947). The probability of symptoms resolution at day 14 was similar in the two groups (aHR 1.16;0.65-2.09;p=0.614). Conclusion: A less severe presentation and no difference in clinical outcomes with Covid-19 even in the adjusted models were observed in PLWH compared to non-PLWH, but further investigations are warranted due to the small sample size of HIV+ population. (Figure Presented).