ABSTRACT
Background: Reports of severity of illness and outcomes of SARS-CoV-2 infection in persons living with HIV (PLWH) vary across cohorts. Limited data exists regarding post-infection complications among PLWH. Methods: We examined the clinical characteristics and outcomes among PLWH infected with SARS-CoV-2 compared to an age and race matched cohort in a healthcare system composed of ten academic and community-based hospitals in the mid-Atlantic United States. Descriptive statistics were used and multivariate logistic regression analyses were performed to explore factors associated with incident hospitalization and death/mechanical ventilation among PLWH. Results: Between March 2020 and November 2020, 281 d PLWH were diagnosed with SARS-CoV-2 infection among 1632 tested. The mean age was 51.5 years (SD: 12.74), 63% (n=177) were male, and 86% (n=237) were African-American/Black. The median CD4+ T lymphocyte count was 623 cells/mm3 [383, 938] and 87% had a HIV viral load <200 copies/mL. More PLWH were hospitalized than age/sex matched HIV-seronegative controls, 47% (n=132/281) versus 24% (n=269/1124), (p<0.001). Rates of post-Coronavirus Disease 2019 (COVID-19) cardiovascular, thrombotic, acute kidney injury, and concurrent infections were similar between PLWH and HIV-seronegative individuals. All cause mortality was similar between PLWH and HIV-seronegative individuals, 14% versus 13% (p=0.75). In adjusted analyses, hospitalization among PLWH with COVID-19 was associated with older age aOR 1.03 (95% CI 1.03, 1.06, p=0.022) and Medicaid insurance aOR 2.87 (95% CI 1.45, 5.78, p=0.003). Conclusion: In an age/sex matched cohort, PLWH with well-controlled HIV and SARS-CoV-2 infection had higher rates of hospitalization but similar mortality rates compared with HIV-seronegative individuals. Despite higher rates of hospitalization and higher comorbidity burden, rates of post-COVID-19 events were similar. However, older age and Medicaid insurance status associated with more severe disease among PLWH suggesting the importance of targeted interventions to mitigate the effects of modifiable inequities.