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Source/Disclosures
Disclosures: Bhaskaran holds a Sir Henry Dale fellowship jointly funded by Wellcome and the Royal Society. Please see the study for all other authors’ relevant financial disclosures.
December 22, 2020
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In UK study, people with HIV at increased risk for death from COVID-19

Source/Disclosures
Disclosures: Bhaskaran holds a Sir Henry Dale fellowship jointly funded by Wellcome and the Royal Society. Please see the study for all other authors’ relevant financial disclosures.
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A study of more than 17 million people in England revealed that those living with HIV had a higher risk for death from COVID-19 than people without HIV, according to findings published in The Lancet HIV.

Researchers reported that the risk was even greater among Black people with HIV.

Microscopic HIV
People with HIV are at more than twice the risk for COVID-19 death compared with people without HIV, a UK study found.

“HIV is a virus that attacks the immune system, so there was a concern that people living with HIV might have higher risks of experiencing severe COVID-19 than the general population,” Krishnan Bhaskaran, PhD, professor of statistical epidemiology and Sir Henry Dale Fellow at the London School of Hygiene & Tropical Medicine, told Healio. “We wanted to investigate this by comparing risks of dying from COVID-19 between people with and without HIV.”

Bhaskaran and colleagues performed a retrospective cohort study using the OpenSAFELY platform to analyze routinely collected electronic primary care data linked to national death registrations. According to the study, all adults aged 18 years or older who were alive and in follow-up on Feb. 1 and had at least 1 year of continuous registration with a general practitioner before this date were included in the study.

The researchers compared patients with a primary care record for HIV infection with those without HIV and used Cox regression models to estimate the association between HIV infection and COVID-19 death.

In total, 17,282,905 adults were included in the study, including 27,480 with HIV. In all, 14,882 COVID-19 deaths occurred during the study period, with 25 among people with HIV.

According to the researchers, after adjusting for age and sex, people with HIV had higher risk for COVID-19 death than those without HIV (HR = 2.90; 95% CI, 1.96–4.30). They found that the association was lessened after adjusting for deprivation, ethnicity, smoking and obesity (aHR = 2.59; 95% CI, 1.74–3.84), although the risk remained high.

Additionally, the study demonstrated some evidence that the association was larger among Black people with HIV (HR = 4.31; 95% CI, 2.42–7.65 in Black people with HIV versus HR = 1.84; 95% CI, 1.03–3.26 in non-Black people with HIV).

“The overall rates of COVID-19 death were still quite low among people with HIV. This is because old age is the most important risk factor, and there are relatively few elderly people living with HIV — in our study, fewer than 5% of those with HIV were over 70 years old,” Bhaskaran said. “Nevertheless, our findings indicate that there may be a need to consider HIV status when deciding on priority groups for vaccination. It will also be important to do more research to understand why HIV seemed to have a disproportionate association with risk in people of Black ethnicity, so that this can be addressed in risk reduction strategies.”

The findings aligned with results from a South African study that showed HIV and tuberculosis were associated with increased COVID-19 mortality, but other studies in the United States and elsewhere have fond no association between HIV and worse outcomes from COVID-19.