Background

WHO has established a Global Clinical Platform for the clinical characterisation of COVID-19 among hospitalised individuals. We assessed whether people living with HIV hospitalised with COVID-19 had increased odds of severe presentation and of in-hospital mortality compared with individuals who were HIV-negative and associated risk factors.

Methods

Between Jan 1, 2020, and July 1, 2021, anonymised individual-level data from 338 566 patients in 38 countries were reported to WHO. Using the Platform pooled dataset, we performed descriptive statistics and regression analyses to compare outcomes in the two populations and identify risk factors.

Findings

Of 197 479 patients reporting HIV status, 16 955 (8·6%) were people living with HIV. 16 283 (96.0%) of the 16 955 people living with HIV were from Africa; 10 603 (62·9%) were female and 6271 (37·1%) were male; the mean age was 45·5 years (SD 13·7); 6339 (38·3%) were admitted to hospital with severe illness; and 3913 (24·3%) died in hospital. Of the 10 166 people living with HIV with known antiretroviral therapy (ART) status, 9302 (91·5%) were on ART. Compared with individuals without HIV, people living with HIV had 15% increased odds of severe presentation with COVID-19 (aOR 1·15, 95% CI 1·10–1·20) and were 38% more likely to die in hospital (aHR 1·38, 1·34–1·41). Among people living with HIV, male sex, age 45–75 years, and having chronic cardiac disease or hypertension increased the odds of severe COVID-19; male sex, age older than 18 years, having diabetes, hypertension, malignancy, tuberculosis, or chronic kidney disease increased the risk of in-hospital mortality. The use of ART or viral load suppression were associated with a reduced risk of poor outcomes; however, HIV infection remained a risk factor for severity and mortality regardless of ART and viral load suppression status.

Interpretation

In this sample of hospitalised people contributing data to the WHO Global Clinical Platform for COVID-19, HIV was an independent risk factor for both severe COVID-19 at admission and in-hospital mortality. These findings have informed WHO immunisation policy that prioritises vaccination for people living with HIV. As the results mostly reflect the data contribution from Africa, this analysis will be updated as more data from other regions become available.

Funding

None.

Translation

For the French translation of the abstract see Supplementary Materials section.

中文翻译：

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入院的 HIV 感染者中严重或致命的 COVID-19 的临床特征和风险因素：来自世卫组织 COVID-19 全球临床平台的数据分析

背景

世卫组织建立了一个全球临床平台，用于在住院患者中对 COVID-19 进行临床表征。我们评估了与 HIV 阴性和相关危险因素的个体相比，因 COVID-19 住院的 HIV 感染者出现严重症状和住院死亡率的几率是否增加。

方法

2020 年 1 月 1 日至 2021 年 7 月 1 日期间，向世卫组织报告了来自 38 个国家的 338 566 名患者的匿名个人数据。使用平台合并数据集，我们进行了描述性统计和回归分析，以比较两个人群的结果并确定风险因素。

发现

在报告 HIV 感染状况的 197 479 名患者中，有 16 955 名（8·6%）是 HIV 感染者。16 955 名艾滋病病毒感染者中有 16 283 人（96.0%）来自非洲；女性10603人（62·9%），男性6271人（37·1%）；平均年龄为 45·5 岁 (SD 13·7)；重症入院6339人（38·3%）；3913 (24·3%) 人在医院死亡。在 10166 名已知接受过抗逆转录病毒疗法 (ART) 治疗的 HIV 感染者中，有 9302 人 (91·5%) 接受了 ART。与未感染 HIV 的人相比，HIV 感染者因 COVID-19 而出现严重症状的几率增加 15%（aOR 1·15，95% CI 1·10–1·20），并且在医院死亡的可能性增加 38%（ aHR 1·38, 1·34–1·41)。在 HIV 感染者中，年龄在 45-75 岁之间的男性以及患有慢性心脏病或高血压的人患重症 COVID-19 的几率增加；男性，年龄超过 18 岁，患有糖尿病、高血压、恶性肿瘤、肺结核或慢性肾病会增加院内死亡的风险。使用 ART 或病毒载量抑制与降低不良结果的风险相关；然而，无论 ART 和病毒载量抑制状态如何，HIV 感染仍然是严重程度和死亡率的危险因素。

解释

在这个向世卫组织 COVID-19 全球临床平台提供数据的住院患者样本中，HIV 是入院时严重 COVID-19 和院内死亡率的独立危险因素。这些发现为世卫组织免疫政策提供了依据，该政策优先为艾滋病毒感染者接种疫苗。由于结果主要反映了非洲的数据贡献，因此随着来自其他地区的更多数据可用，该分析将得到更新。

资金

没有任何。

翻译

有关摘要的法语翻译，请参阅补充材料部分。