ABSTRACT
Background: Evidence on the association between HIV infection and the risk of poor clinical outcomes in people with COVID-19 remains inconclusive. The World Health Organization (WHO) has established a Global Clinical Platform aimed to assess clinical features and risk factors for severe/fatal COVID-19 among individuals hospitalized with suspected or confirmed SARS-CoV-2 infection.Methods: Between January 2020-June 2021 anonymized individual-level clinical data from 338,566 patients hospitalized in 38 countries were reported to the WHO Clinical Platform using a standardized set of variables including demographics, vital signs, underlying conditions, laboratory values, therapeutics and medical care received, and clinical outcomes. Descriptive and regression analyses whether HIV status was a risk factor for severity at admission and in-hospital mortality among people hospitalized for COVID-19.Findings: Of 197,479 patients reporting HIV status, 8.6% (16,955) were living with HIV (PLHIV), and 94.6% (16,283) were from Africa. Among those, 37.1% were male, mean age was 45.5 years, 38.3% were admitted with severe or critical illness and 24.7% died in-hospital. Among 10,166 individuals with information about antiretroviral therapy (ART) status, 91.5% were on ART. When compared to those without HIV, PLHIV had 15% increased odds of severe/critical presentation (aOR=1.15, 95%CI 1.10–1.20) and 38% more likely to die in-hospital (aHR=1.38, 95%CI 1.34-1.41). Among PLHIV, being male, age 45-75 years, having chronic cardiac disease or hypertension increased the odds of severe/critical COVID-19; male sex, age>18 years, having diabetes, hypertension, malignancy, TB, or chronic kidney disease increased the risk of in-hospital mortality.Interpretation: In this sample of hospitalized people contributing data to the WHO Global Clinical Platform for COVID-19, HIV was a significant independent risk factor for both severe/critical COVID-19 at admission and in-hospital mortality. These findings have informed the WHO COVID-19 Clinical Management Guidelines and SAGE recommendations around COVID-19 vaccination prioritization among vulnerable groups.Funding Information: None.Declaration of Interests: R.H. received funding from the Wellcome Trust, CIHR UKRI/MRC and ICODA. None of the other authors have any conflicts of interest to disclose.Ethics Approval Statement: The analysis plan25 was submitted to the WHO Ethical Review Committee which granted a waiver from ethical review clearance as this was passive, anonymized clinical surveillance. Ethical clearance was obtained, where necessary, by relevant institutional or national bodies.