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: To study whether people living with HIV (PLWH) are at higher risk of in-hospital COVID-19 mortality compared to general population (GenPop). Methods: Retrospective study in 19 Italian centres (Feb2020-Nov2022) including hospitalized PLWH and GenPop with SARS-CoV-2 infection. Main outcome: 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: 7,399 COVID-19 patients were included, 239 (3·2%) PLWH, and 7,160 (96·8%) GenPop. By day 40, in-hospital death occurred in 1,283/7,160 (17·9%) among the 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 the GenPop ≥65 [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.