Risk of COVID-19 in-hospital mortality in people living with HIV compared to general population according to age and CD4 strata: data from the ICONA network.

Objectives: We aimed to study whether people living with HIV (PLWH) are at higher risk of in-hospital COVID-19 mortality compared to the general population (GenPop).
Methods: This was a retrospective study in 19 Italian centers (February 2020 to November 2022) including hospitalized PLWH and GenPop with SARS-CoV-2 infection. The main outcome was in-hospital mortality. Competing risk analyses by Fine-Gray regression model were used to estimate the association between in-hospital mortality and HIV status/age.
Results: A total of 7399 patients with COVID-19 were included, 239 (3.2%) PLWH, and 7160 (96.8%) GenPop. By day 40, in-hospital death occurred in 1283/7160 (17.9%) among GenPop and 34/239 (14.2%) among PLWH. After adjusting for potential confounders, compared to GenPop <65 years, a significantly higher risk of death was observed for GenPop ≥65 (adjusted subdistribution hazard ratio [aSHR] 1.79 [95% CI 1.39-2.31]), PLWH ≥65 (aSHR 2.16 [95% CI 1.15-4.04]), PLWH <65 with CD4 ≤200 (aSHR 9.69 [95% CI 5.50-17.07]) and PLWH <65 with CD4 201-350 (aSHR 4.37 [95% CI 1.79-10.63]), whereas no evidence for a difference for PLWH <65 with CD4 >350 (aSHR 1.11 [95% CI 0.41-2.99]).
Conclusions: In PLWH aged <65 years a CD4 ≤350 rather than HIV itself seems the driver for the observed higher risk of in-hospital mortality. We cannot however rule out that HIV infection per se is the risk factor in those aged ≥65 years.
Competing Interests: Declarations of competing interest A Giacomelli reports speakers’ honoraria for ViiV Healthcare and Gilead Sciences, advisor for Janssen-Cilag and Mylan; RG reports payments to her institution from Gilead Sciences, speakers’ honoraria for ViiV Healthcare, Merck Sharp and Dohme and Gilead Sciences, advisor for Thera Technologies, Janssen-Cilag and Gilead Sciences; GR reports consultancies/advisory from ViiV Healthcare, GSK, Merck Sharp and Dohme and Gilead Sciences; A Gori received speaker's honoraria and fees for attending advisory boards from ViiVHealthcare, Gilead, Janssen-Cilag, Merck Sharp & Dohme, Bristol-Myers Squibb, Pfizer and Novartis and received research grants from ViiV, Bristol-Myers Squibb, and Gilead; AM received speakers’ honoraria from Gilead Sciences, and ViiV Healthcare, travel fee from Viiv Healthcare and participated in advisory boards sponsored by ViiV Healthcare; AV received an institutional grant from Gilead Sciences, speakers’ honoraria/educational activities from Merck Sharp & Dohme and Janssen-Cilag, and served an advisor for Janssen-Cilag; MM received speakers’ honoraria from ViiV Healthcare; LT reports consultancies/advisory from Viiv Healthcare, Gilead Sciences and Janssen-Cilag and institutional fellowship from Gilead Sciences; G Marchetti participated to advisory boards of Gilead Sciences, ViiV Healthcare, Angelini and Janssen-Cilag, and received travel grants from ViiV Healthcare and Janssen-Cilag; AdM participated in advisory board of Gilead Sciences, ViiV Healthcare, Merck Sharp and Dohme, Pfizer and GSK and reports research grant from Gilead Science, ViiV Healthcare, Merck Sharp and Dohme, GSK and Janssen-Cilag; AA received Research grants from Gilead Sciences, AstraZeneca, ViiV Healthcare and Honoraria from Gilead Science, AstraZeneca, GSK, Pfizer, Merck Sharp and Dohme, Moderna, Mylan, Janssen-Cilag, ViiV Healthcare; AT, SDB, SA, G Mancarella, FMF, ADV, VM, MA and ACL have nothing to declare.
(Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)