HIV-positive patients may present lungs with multiple infections, which may hinder differential diagnoses and the choice of treatment in the course of COVID-19, especially in countries with limited access to high-standard healthcare. Here, we aim to investigate the association between radiological changes and poor COVID-19 outcomes among HIV-positive patients from Central and Eastern Europe. Between November 2020 and May 2021, the Euroguidelines in Central and Eastern Europe Network Group started collecting observational data on HIV and COVID-19 co-infections. In total, 16 countries from Central and Eastern European submitted data (eCRF) on 557 HIV-positive patients. The current analyses included patients who had a radiological examination performed. Logistic regression models were used to identify the factors associated with death, ICU admission, and partial recovery (poor COVID-19 outcomes). Factors that were significant in the univariate models (p < 0.1) were included in the multivariate model. Radiological data were available for 224 (40.2%) patients, 108 (48.2%) had computed tomography, and 116 (51.8%) had a chest X-ray. Of these, 211 (94.2%) were diagnosed using RT-PCR tests, 212 (94.6%) were symptomatic, 123 (55.6%) were hospitalized, 37 (16.6%) required oxygen therapy, and 28 (13.1%) either died, were admitted to ICU, or only partially recovered. From the radiologist’s description, 138 (61.6%) patients had typical radiological changes, 18 (8.0%) atypical changes, and 68 (30.4%) no changes. In the univariate models, CD4 count (OR = 0.86 [95% CI: 0.76−0.98]), having a comorbidity (2.33 [1.43−3.80]), HCV and/or HBV co-infection (3.17 [1.32−7.60]), being currently employed (0.31 [0.13−0.70]), being on antiretroviral therapy (0.22 [0.08−0.63]), and having typical (3.90 [1.12−13.65]) or atypical (10.8 [2.23−52.5]) radiological changes were all significantly associated with poor COVID-19 outcomes. In the multivariate model, being on antiretroviral therapy (OR = 0.20 [95% CI:0.05−0.80]) decreased the odds of poor COVID-19 outcomes, while having a comorbidity (2.12 [1.20−3.72]) or either typical (4.23 [1.05−17.0]) or atypical (6.39 [1.03−39.7]) radiological changes (vs. no changes) increased the odds of poor COVID-19 outcomes. Among HIV patients diagnosed with symptomatic SARS-CoV-2 infection, the presence of either typical or atypical radiological COVID-19 changes independently predicted poorer outcomes.

Astar Medical Center 79041 Lviv Ukraine

Department for AIDS Specialized Hospital for Active Treatment of Infectious and Parasitic Disease Sofia Medical University of Sofia 1233 Sofia Bulgaria

Department for Infectious Diseases Faculty of Medicine University of Banja Luka Republika Srpska 78000 Banja Luka Bosnia and Herzegovina

Department of Adults' Infectious Diseases Hospital for Infectious Diseases Medical University of Warsaw 01 201 Warsaw Poland

Department of Infectious and Tropical Diseases and Hepatology Medical University of Warsaw 01 201 Warsaw Poland

Department of Infectious Diseases 1st Faculty of Medicine Faculty Hospital Bulovka Hospital Charles University Prague 18081 Prague Czech Republic

Department of Infectious Diseases and Clinical Microbiology Faculty of Medicine Ege University 35100 Izmir Turkey

Department of Infectious Diseases Belarusian State Medical University Dzerginskogo 83 220116 Minsk Belarus

Department of Pharmacology Clinical Pharmacology and Toxicology School of Medicine; University of Belgrade Dr Subotica 1 3 24101 Belgrade Serbia

Faculty of Medicine in Plzeň University Hospital Plzeň Charles University 30599 Plzen Czech Republic

Faculty of Medicine Vilnius University Hospital Santaros Klinikos Vilnius University 08410 Vilnius Lithuania

Infectious Disease Service University Hospital Center of Tirana Rr Didres Nr 372 33979 Tirana Albania

Infectious Diseases AIDS and Clinical Immunology Center 16 Al Kazbegi Ave 0102 Tblisi Georgia

Medical School University General Hospital Attikon National and Kapodistrian University of Athens 12462 Athens Greece

National Institute of Hematology and Infectious Diseases South Pest Central Hospital National Center of HIV 1097 Budapest Hungary

School of Medicine University Hospital for Infectious Diseases University of Zagreb Miorogojska 8 10000 Zagreb Croatia

Victor Babes Clinical Hospital for Infectious and Tropical Diseases Carol Davila University of Medicine and Pharmacy 030303 Bucharest Romania

Viral Hepatitis and AIDS Department Gromashevsky Institute of Epidemiology and Infectious Diseases Amosova str 5 a 03038 Kyiv Ukraine

West Tallinn Central Hospital Paldiski Road 62 10149 Tallin Estonia

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