# Morbidity and risk factors of COVID‐19 in people with HIV‐1 in Europe: A combined observational cohort and nested case–control study

## TL;DR

This study finds that people with HIV who get COVID-19 have higher rates of certain comorbidities and longer hospital stays compared to those without HIV.

## Contribution

The study identifies specific risk factors for severe outcomes in people with HIV and COVID-19 using a large observational and case–control design.

## Key findings

- PLWH with COVID-19 had significantly higher rates of chronic kidney disease, COPD, and other comorbidities compared to HIV-uninfected patients.
- Higher BMI, uncontrolled HIV viral load, and CDC stage B were significant risk factors for COVID-19 in PLWH.
- PLWH with COVID-19 had longer hospital and ICU stays but similar critical care admission or death rates as HIV-uninfected patients.

## Abstract

To study the COVID‐19 disease course in people living with HIV (PLWH) based on meaningful case numbers, information about comorbidities, antiretroviral and COVID‐19 treatment and HIV disease‐related variables.

Multi‐centre, observational, retrospective study of people living with HIV with COVID‐19 matched to HIV‐uninfected individuals with COVID‐19 (HUC) and a case–control study of people living with HIV with COVID‐19 matched to COVID‐19 negative people living with HIV. Kaplan–Meier estimates and Cox proportional‐hazards models stratified on each matched pair were used for COVID‐19 outcomes, and conditional logistic regression models were used to identify risk factors for COVID‐19 infection.

Five hundred people living with HIV and COVID‐19, 1106 HUC and 992 people living with HIV without COVID‐19 were included. Rates for chronic kidney disease, peripheral vascular disease, dementia, prior pneumonia and liver disease in people living with HIV with COVID‐19 were significantly higher by 4.1‐, 2.9‐, 2.6‐, 2.4‐ and 1.6‐fold, respectively, compared to HIV seronegative COVID‐19 patients. Chronic kidney disease, chronic obstructive pulmonary disease (COPD), body mass index (BMI) ≥30 kg/m2, Centers for Disease Control and Prevention stage B versus A and HIV viral load ≥50 copies/mL were significant risk factors for COVID‐19 in people living with HIV. Critical care admission or death in people living with HIV was comparable to HUC, whilst people living with HIV stayed longer in hospital (11 vs. 9 days) and in intensive care unit (ICU) (18 vs. 7 days) and had a higher age‐adjusted Charlson comorbidity index.

Our study highlights the importance of a well‐controlled HIV infection to prevent severe COVID‐19‐related outcomes. In people living with HIV and COVID‐19, chronic kidney disease and a higher Charlson comorbidity index are risk factors that should prompt early treatment of COVID‐19.