HIV was independently associated with a higher risk for severe or critical COVID-19, according to a World Health Organization (WHO) analysis.

In a study of people living with HIV in Asia, Europe, Africa, and South America who also were hospitalized for COVID-19, HIV infection was linked with an increased risk of severe or critical COVID-19 presentation (OR 1.13, 95% CI 1.09-1.17), after adjusting for age, sex and comorbidity burden, reported Silvia Bertagnolio, MD, of WHO in Geneva, Switzerland.

In addition, HIV infection was tied to a higher risk of inhospital mortality (adjusted HR 1.30, 95% CI 1.24-1.36), she said during a press conference at the International AIDS Society (IAS) virtual meeting.

“This 30% increase risk of dying in the hospital among persons living with HIV is independent of age, gender, severity of disease at admission, and of comorbidity,” Bertagnolio explained.

IAS President Adeeba Kamarulzaman, MBBS, the press conference moderator, called the inhospital mortality rate “astonishing…this study underscores the importance of countries including all people living with HIV in the list of priority populations for national COVID-19 vaccine programs.”

“It is also critical that health systems maintain HIV services during the COVID-19 pandemic, particularly in countries with high HIV prevalence,” stressed Kamarulzaman, who is a member of the WHO Science Council. “Unfortunately, as we know, countries in sub-Saharan Africa with the highest burden of HIV are not currently receiving much COVID-19 vaccine coverage, and this needs to change.”

“The global community must also do much more to bring COVID-19 vaccines to countries around the world with high prevalence of HIV and other diseases,” Kamarulzaman said in a statement. “It is unacceptable that as of today, less than 3% of the entire African continent has received a single dose of the vaccine and less than 1.5% have received both doses.”

Bertagnolio said that previous evidence regarding the impact of HIV infection on the severity and mortality of COVID-19 has been limited and sometimes conflicting, and most analyses have been based on relatively small cohorts of individuals in specific settings.

Her group looked at patients hospitalized for COVID-19 between January 2020 and April 2021 (n=168,649; 37 countries), and identified those (n=15,522; 24/37 countries) who also had HIV. Patient age was about 45 and 37.1% were men; 91.8% of those with HIV were on antiretroviral therapy. Bivariate and regression analyses were conducted to determine whether HIV status was a risk factor for severity at admission and in-hospital mortality. The models were adjusted for potential correlation for clustering at the country level.

At presentation, 36.2% of those with HIV had severe or critical COVID-19 symptoms. Of those patients with a known outcome, 23.1% died from COVID-19, the authors reported. Among the patients with HIV infection who died inhospital, other associated significant risk factors for higher mortality were age >65 (OR 1.82, 95% CI 1.62-2.04), being male (OR 1.21, 95%CI 1.15-1.28), having diabetes (OR 1.50, 95% CI 1.39-1.62), and having a hypertension diagnosis (OR 1.26, 95% CI 1.19-1.34).

Data for the analysis came from the WHO Global Clinical Platform for COVID-19. Bertagnolio said that, based on the study results, WHO intends to add HIV infection as a risk factor in its clinical guidelines for COVID-19. She called the data “a living analysis,” that will be updated routinely.