Abstract:
BACKGROUND : HIV infection causes immune dysregulation affecting T-cell and monocyte
function, which may alter coronavirus disease 2019 (COVID-19) pathophysiology.
OBJECTIVES : We investigated the associations among clinical phenotypes, laboratory
biomarkers, and hospitalisation outcomes in a cohort of people hospitalised with COVID-19 in
a high HIV prevalence area.
METHOD : We conducted a prospective observational cohort study in Tshwane, South Africa.
Respiratory disease severity was quantified using the respiratory oxygenation score. Analysed
biomarkers included inflammatory and coagulation biomarkers, CD4 T-cell counts, and HIV-1
viral loads (HIVVL).
RESULTS : The analysis included 558 patients, of whom 21.7% died during admission. The mean
age was 54 years. A total of 82 participants were HIV-positive. People living with HIV (PLWH)
were younger (mean age 46 years) than HIV-negative people; most were on antiretroviral
treatment with a suppressed HIVVL (72%) and the median CD4 count was 159 (interquartile
range: 66–397) cells/μL. After adjusting for age, HIV was not associated with increased risk of
mortality during hospitalisation (age-adjusted hazard ratio = 1.1, 95% confidence interval:
0.6–2.0). Inflammatory biomarker levels were similar in PLWH and HIV-negative patients.
Detectable HIVVL was associated with less severe respiratory disease. In PLWH, mortality
was associated with higher levels of inflammatory biomarkers. Opportunistic infections, and
other risk factors for severe COVID-19, were common in PLWH who died.
CONCLUSION : PLWH were not at increased risk of mortality and those with detectable HIVVL
had less severe respiratory disease than those with suppressed HIVVL.
