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December 8, 2021

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HIV and COVID-19: Worse Outcomes With Dropping CD4+ Cell Counts

By Erica Kaufman West, MD.

While early reports of hospitalized patients with HIV and COVID-19 showed good outcomes, there was concern that patients with HIV were admitted more readily than patients without HIV, thus skewing hospital outcomes toward a more positive result. Researchers in San Francisco looked at the impact of HIV status on COVID-19 outcomes over the first year of the COVID-19 pandemic. They conducted a population-level match of the COVID-19 registry of the San Francisco Department of Public Health with the clinic rosters of the San Francisco Primary Care Clinics from Feb. 1, 2020, to March 1, 2021, including one of the largest HIV clinics in San Francisco, Ward 86. They gathered data on the COVID-19 attack rate, the testing rate, the clinical outcomes by HIV status and the COVID-19 outcomes including oxygen requirements and death rate.

Of the 22,024 participants, 2,690 were persons with HIV (PWH). The incidence of SARS-CoV-2 was 79.1 per 1,000 person-years in patients without HIV versus 34.7 per 1,000 person-years in PWH. When adjusting for baseline demographics, the rate of SARS-CoV-2 was 40% lower among PWH despite PWH having an 8% higher testing rate. There were 1,915 cases of SARS-CoV-2 in the year evaluated, with 136 of them in PWH. Researchers chose 591 PWH to make a sub-cohort for comparison. The risk of hospitalization for SARS-CoV-2 was 90% higher among PWH with a risk of severe COVID-19 being 84% higher than non-HIV. The adjusted relative risk for requiring ventilator use among PWH was 1.58 and for death was 1.90 (95% confidence interval: 0.52-4.83 and 0.37-9.69, respectively). In some form of a silver lining, they found that the risk of severe COVID-19 requiring supplemental oxygen was 30% lower for each 100 CD4+ cell increase. Not surprisingly, those with CD4+ cell counts < 200 cell/μL had a 150% higher risk for severe COVID-19. Vaccine distribution was just starting at the time the study period ended, so efficacy could not be evaluated.

This paper is a call for HIV providers to engage their patients with HIV in both antiretroviral therapy compliance as well as SARS-CoV-2 vaccination, including – as we now know – the importance of the three-shot series. Reminding these patients of the importance of social distancing and masking, especially during times of surges, remains essential especially among Latinx patients who have higher attack rates and worse outcomes overall.

(Spinelli et al. AIDS. 2021;35(15):2545-2547.)

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