CLINICAL OUTCOME in PEOPLE with COVID-19 by HIV-STATUS: A NATIONWIDE REGISTER STUDY

ABSTRACT

Background: It is still unclear whether people with HIV (PWH) are more likely to have severe outcome of COVID-19. We aimed to assess this association using nation-wide register data. Methods: We included all adults hospitalized with a primary diagnosis of COVID-19 (ICD-10;U07.1, U07.2) in Sweden between Feb 1, 2020, and Aug 31, 2021, identified from the National Patient Register. The study population was linked to the National HIV Quality Register (n= 8 032), the Swedish Intensive Care Register, the Swedish Cause of Death Register, and the LISA database for labour market studies. Using multivariate logistic regression models, we estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for severe COVID-19 (intensive care admission or 90-day mortality), by HIV-status. Results: We included 121 PWH and 64 764 HIV-negative individuals hospitalized with COVID-19. PWH were younger (median age 57y vs. 65y, p<0.001) and more likely to be men (68% vs. 57%, p=0.015) compared to HIV-negative. There was no difference in level of education, level of income or number of comorbidities. Most hospitalized PWH had undetectable HIV-RNA (93%) and high CD4 counts (median 560, IQR 376-780). Severe COVID-19 was identified in 17 (14%) PWH and 14 648 (23%) HIV-negative. Ten (8%) PWH and 10 217 (16%) HIV-negative died within 90 days. HIV status was not associated with higher odds of severe COVID-19 (aOR 0.88, 95% CI 0.52-1.49). Higher age was associated with severe COVID-19 in PWH (aOR 1.08, 95% CI 1.02-1.15). PWH with one or more comorbidities were four times more likely to have severe COVID-19 (aOR 4.3, 95% CI 1.1-16.7, ref PWH with no comorbidity). Neither level of income nor level of education or migrant status was associated with severe COVID-19 in PWH. Level of HIV-RNA, current CD4, nadir CD4, and mode of HIV-transmission was not associated with severe COVID-19. PWH admitted to the ICU were six times more likely treated with tocilizumab compared to HIV-negative admitted to the ICU (aOR 6.1, 95% CI 1.5-24.5), even after adjusting for regional differences in early adoption of tocilizumab use. There was no difference in the number treated with steroids (aOR 0.9, 95% CI 0.2-3.1). Conclusion: This nation-wide cohort study, including the entire Swedish adult population hospitalized with COVID-19, indicates that PWH with well-treated HIV-infection have similar odds of severe COVID-19 as HIV-negative individuals. PWH admitted to the ICU were more likely treated with tocilizumab compared to HIV-negative.