Isabela Killander Möller[1], Magnus Gisslén[2,3], Philippe Wagner[4,5], Pär Sparén[6], Christina Carlander[1,5,6,7]

Affiliates

1. Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden. 2. Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 3. Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden 4. Lund University, Department of Clinical Sciences, Lund, Orthopedics 5. Centre for Clinical Research Västmanland, Västmanland County Hospital, Uppsala University, Västerås, Sweden 6. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden 7. Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden

Abstract

Background: To assess the outcome of patients hospitalized with COVID-19 by HIV-status and risk factors associated with severe COVID-19 in people living with HIV (PWH), we performed a nationwide study using register data.
Methods: All persons 18 years or older hospitalized with a primary COVID-19 diagnosis (U07.1 or U07.2) in Sweden between February 2020, and October 2021, were included. Comorbidity, sociodemographics, and HIV-related variables were collected. Regression analyses were performed to assess severe COVID-19 (ICU admission or 90-day mortality) by HIV-status and risk factors. Time of follow-up was divided in three time periods illustrating the SARS-CoV-2 waves.
Results: Data from 64,815 hospitalized patients were collected of whom 121 were people with HIV (PWH) (0.18%). PWH were younger (p<0.000), a larger proportion were men (p=0.014) and migrants (p<0.000). Almost all PWH had undetectable HIV-RNA (93%) and high CD4+T-cell counts (median 560, IQR 376-780). The proportion of severe COVID-19 was lower in PWH compared to patients without HIV (14% CI 9-21% vs. 22% CI 22-23%, p=0.029), but there was no statistically significant difference after adjusting for age and comorbidity (adjOR 0.7 95% CI 0.43-1.26). A lower proportion of PWH (8%, CI 5-15%) died within 90 days compared to without HIV (16%, CI 15-16%, p=0.024). The proportion with severe COVID-19 was lower in the third wave compared to the first in patients without HIV (16 vs 25%) but not in PWH (18 vs 14%).
Conclusions: In this nationwide study including well-treated PWH, HIV was not a risk factor in hospitalized patients for developing severe COVID-19.