People with HIV (PWH) might have a higher risk of adverse coronavirus disease 2019 (COVID-19) outcomes. Several scores were developed to predict COVID-19 progression to critical disease and are often used among PWH. We assessed the performance of two commonly used risk equations among PWH and COVID-19. Participants were identified from a multicenter cohort of 6,361 PWH on regular follow-up at 2 university hospitals. Of 99 HIV-infected individuals with confirmed SARS-CoV-2 infection, 63 had complete data and were included in this analysis. CALL and COVID-GRAM scores were calculated and participants were stratified into low-, intermediate-, and high-risk groups for each. Discrimination was assessed using receiver operating characteristic curves. Calibration was evaluated using observed versus expected (O:E) ratios and the Hosmer–Lemeshow χ² goodness-of-fit statistic. Scores were adjusted by increasing one category level in individuals with nadir CD4 lymphocyte count <200/μL. Participants had a median nadir and current CD4 counts of 207 [interquartile range (IQR) 119–345] and 440 (IQR 280–719) cells/μL. Ten (15.9%) individuals progressed to critical disease and 4 (6.3%) died. Assessed scores showed acceptable discrimination (area under the curve 0.701–0.771) and were overall calibrated (O:E ratio 1.01). However, both overestimated the risk of progression among individuals in the low- and high-risk categories, whereas they underestimated the risk in the intermediate category (O:E 1.20–1.21). Thus, 50% of critically ill individuals were not identified as high risk. Assigning PWH with low nadir CD4 counts a higher risk of progression reduced the proportion of individuals not identified to 20%. COVID-19 risk scores had lower performance in PWH compared with that described in the general population and failed to adequately identify individuals who progressed to critical disease. Adjustment for nadir CD4 partially improved their accuracy. Risk equations incorporating HIV-related factors are needed.

中文翻译：

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HIV 和 COVID-19 患者的进展风险：当前风险评分的预测性能

HIV 感染者 (PWH) 患 2019 年冠状病毒病 (COVID-19) 结果的风险可能更高。开发了几种评分来预测 COVID-19 进展为危重疾病，并且经常用于 PWH。我们评估了 PWH 和 COVID-19 中两个常用风险方程的性能。参与者是从 2 所大学医院定期随访的 6,361 名 PWH 的多中心队列中确定的。在 99 名确诊感染 SARS-CoV-2 的 HIV 感染者中，63 人拥有完整的数据并被纳入本分析。计算 CALL 和 COVID-GRAM 评分，并将参与者分为低、中和高风险组。使用接收者操作特征曲线评估区分。使用观察到的与预期的 (O:E) 比率和 Hosmer-Lemeshow χ²拟合优度统计。通过在最低点 CD4 淋巴细胞计数 <200/μL 的个体中增加一个类别水平来调整分数。参与者的中位最低点和当前 CD4 计数为 207 [四分位距 (IQR) 119–345] 和 440 (IQR 280–719) 个细胞/μL。10 人 (15.9%) 进展为危重疾病，4 人 (6.3%) 死亡。评估分数显示出可接受的区分度（曲线下面积 0.701-0.771），并且经过整体校准（O:E 比值 1.01）。然而，两者都高估了低风险和高风险类别个体的进展风险，而低估了中间类别的风险 (O:E 1.20–1.21)。因此，50% 的危重患者未被确定为高危人群。将低最低点 CD4 计数的 PWH 分配为更高的进展风险将未识别的个体比例降低到 20%。与一般人群中描述的相比，COVID-19 风险评分在 PWH 中的表现较低，并且未能充分识别进展为危重疾病的个体。对最低点 CD4 的调整部分提高了它们的准确性。需要包含 HIV 相关因素的风险方程。