BACKGROUND: To date there remains much ambiguity in the literature regarding the immunological interplay between SARS-CoV-2 and HIV and the true risk posed to coinfected individuals. There has been little conclusive data regarding the use of CD4 cell count and HIV viral load stratification as predictors of COVID-19 severity in this cohort. METHODS: We performed a retrospective, observational cohort study on people living with HIV (PLWH) who contracted COVID-19 in central and eastern Europe. We enrolled 536 patients from 16 countries using an online survey. We evaluated patient demographics, HIV characteristics and COVID-19 presentation and outcomes. Statistical analysis was performed using SPSS 20.1. RESULTS: The majority of the study cohort were male (76.4%) and 152 (28.3%) had a significant medical comorbidity. Median CD4 cell count at COVID-19 diagnosis was 605 cells/μL [interquartile range (IQR) 409-824]. The majority of patients on antiretroviral therapy (ART) were virally suppressed (92%). In univariate analysis, CD4 cell count <350 cells/μL was associated with higher rates of hospitalization (p < 0.0001) and respiratory failure (p < 0.0001). Univariate and multivariate analyses found that an undetectable HIV VL was associated with a lower rate of hospitalization (p < 0.0001), respiratory failure (p < 0.0001), ICU admission or death (p < 0.0001), and with a higher chance of full recovery (p < 0.0001). CONCLUSION: We can conclude that detectable HIV viral load was an independent risk factor for severe COVID-19 illness and can be used as a prognostic indicator in this cohort.

Carol Davila University for Medicine and Pharmacy Bucharest Romania

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

Department for AIDS Specialized Hospital for Active Treatment of Infectious and Parasitic Disease Sofia Sofi Bulgaria

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

Department of Adults' Infectious Diseases Medical University of Warsaw Warsaw Poland

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

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

Department of Medicine Galway University Hospital Galway Ireland

Faculty of Medicine University of Belgrade Department of Pharmacology Clinical Pharmacology and Toxicology Belgrade Serbia

Global Fund Grant Management Department Republican Scientific and Practical Center for Medical Technologies Minsk Belarus

Infectious Diseases AIDS and Clinical Immunology Center Tbilisi Georgia

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

Tartu University Hospital Tartu Estonia

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

University Hospital Center of Tirana Infectious Disease Service Tirana Albania

University Hospital for Infectious Diseases University of Zagreb School of Medicine Zagreb Croatia

Victor Babes Clinical Hospital for Infectious and Tropical Diseases Bucharest Romania

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

Viral Hepatitis and AIDS Department Gromashevsky Institute of Epidemiology and Infectious Diseases Kyiv Ukraine

See more in PubMed

World Health Organization. Coronavirus (COVID-19) Dashboard. https://covid19.who.int

Chen C, Chen C, Yan JT, Zhou N, Zhao JP, Wang DW. Analysis of myocardial injury in patients with COVID-19 and association between concomitant cardiovascular diseases and severity of COVID-19. Zhonghua Xin Xue Guan Bing Za Zhi. 2020;48:567-571.

Lewden C, May T, Rosenthal E, et al. Changes in causes of death among adults infected by HIV between 2000 and 2005: the “Mortalite 2000 and 2005” surveys (ANRS EN19 and Mortavic). J Acquir Immune Defic Syndr. 2008;48(5):590-598.

Skrzat-Klapczyńska A, Kase K, Kowalska J. HIV-positive patients diagnosed with COVID-19 in central and eastern European countries. J Clin Lab Anal. 2022;36:e24675. doi:10.1002/jcla.24675

Puła J, Kowalska J, Paciorek M, Bednarska A, Skrzat-Klapczyńska A, Horban A. Late diagnosis of HIV infection in Warsaw: estimating the scale of the problem and demographic trends. HIV Med. 2023;24(1):75-81.

Tesoriero JM, Swain CE, Pierce JL, et al. Elevated COVID-19 outcomes among persons living with diagnosed HIV infection in New York state: results from a population-level match of HIV, COVID-19, and hospitalization databases. medRxiv. 2020:2020.11.04.20226118. doi:10.1101/2020.11.04.20226118. Update in: JAMA Netw Open. 2021 Feb 1;4(2): e2037069.

Huang J, Xie N, Hu X, et al. Epidemiological, virological and serological features of Coronavirus Disease 2019 (Covid-19) cases in people living with human immunodeficiency virus in wuhan: a population-based cohort study. Clin Infect Dis. 2021;73(7):e2086-e2094.

Mazzitelli M, Trunfio M, Sasset L, et al. Factors associated with severe COVID-19 and post-acute COVID-19 syndrome in a cohort of people living with HIV on antiretroviral treatment and with undetectable HIV RNA. Viruses. 2022;14:493. doi:10.3390/v14030493

Euroguidelines in Central and Eastern Europe Network Group. https://eceenetwork.com

Jilich D, Skrzat-Klapaczyńska A, Fleischhans L, et al. National strategies for vaccination against COVID-19 in people living with HIV in central and eastern European region. HIV Med. 2022 May;23(5):546-552. doi:10.1111/hiv.13194

IBM Corp. IBM SPSS Statistics for Windows. IBM Corp; 2017 https://hadoop.apache.org

Prabhu S, Poongulali S, Kumarasamy N. Impact of COVID-19 on people living with HIV: a review. J Virus Erad. 2020;6(4):100019. doi:10.1016/j.jve.2020.100019

Clinical features and prognostic factors of COVID-19 in people living with HIV hospitalized with suspected or confirmed SARS-CoV2 infection. World Health Organization Global Clinical Platform for COVID-19 2021.

Wang M, Luo L, Bu H, Xia H. One case of coronavirus disease 2019 (COVID-19) in a patient co-infected by HIV with a low CD4+ T-cell count. Int J Infect Dis. 2020 Jul;96:148-150. doi:10.1016/j.ijid.2020.04.060

d'Ettorre G, Recchia G, Ridolfi M, et al. Analysis of type I IFN response and T cell activation in severe COVID-19/HIV-1 coinfection: a case report. Medicine (Baltimore). 2020;99(36):e21803. doi:10.1097/MD.0000000000021803

Gao A, Chen Z, Segal FP, Carrington M, Streeck H, Chakraborty AK. Predicting the immunogenicity of T cell epitopes: from HIV to SARS-CoV-2. bioRxiv. 2020: 2020.05.14.095885. doi:10.1101/2020.05.14.095885. Update in: iScience. 2021 April 23;24(4):102311.

Ho HE, Peluso MJ, Margus C, Lopes JPM, He C, Gaisa MM. Clinical outcomes and immunologic characteristics of Covid-19 in people with HIV. J Infect Dis. 2020;223:403-408. doi:10.1093/infdis/jiaa380

Mondi A, Cimini E, Colavita F, Cicalini S, Pinnetti C, Matusali G. COVID-19 in people living with HIV: clinical implications of dynamics of the immune response to SARS-CoV-2. J Med Virol. 2020;93:1796-1804. doi:10.1002/jmv.26556

Han X, Hou H, Xu J, et al. Significant association between HIV infection and increased risk of COVID-19 mortality: a meta-analysis based on adjusted effect estimates. Clin Exp Med. 2022;23:689-700. doi:10.1007/s10238-022-00840-1

Pinnetti C, Vergori A, Agrati C, et al. SARS-CoV-2 infection does not induce HIV viral escape in the central nervous system: a case series. Int J Infect Dis. 2020;101:38-41. doi:10.1016/j.ijid.2020.09.040

Schmidt F, Weisblum Y, Muecksch F, et al. Measuring SARS-CoV-2 neutralizing antibody activity using pseudotyped and chimeric viruses. J Exp Med. 2020;217(11):e20201181.

Shah VK, Firmal P, Alam A, Ganguly D, Chattopadhyay S. Overview of immune response during SARS-CoV-2 infection: lessons from the past. Front Immunol. 2020;7(11):1949. doi:10.3389/fimmu.2020.01949

Mascolo S, Romanelli A, Carleo MA, Esposito V. Could HIV infection alter the clinical course of SARS-CoV-2 infection? when less is better. J Med Virol. 2020;92(10):1777-1778. doi:10.1002/jmv.25881

Patel RH, Acharya A, Chand HS, Mohan M, Byrareddy SN. Human immunodeficiency virus and severe acute respiratory syndrome coronavirus 2 coinfection: a systematic review of the literature and challenges. AIDS Res Hum Retroviruses. 2021;37(4):266-282. doi:10.1089/AID.2020.0284

Pérez-Barragán E, Castillo-Flores JH, Mata-Marín JA, Franco López SG, Morales Martínez BA, Pérez Cavazos S. COVID-19 in people living with HIV: a single-center descriptive study. J Infect Dev Ctries. 2022;16(12):1796-1799. doi:10.3855/jidc.16990

Kowalska JD, Lara M, Hlebowicz M, et al. Non-HIV-related comorbidities and uncontrolled HIV replication are independent factors increasing the odds of hospitalization due to COVID-19 among HIV-positive patients in Poland. Infection. 2023;51:379-387. doi:10.1007/s15010-022-01887-8

Hoffmann C, Casado JL, Härter G, et al. Immune deficiency is a risk factor for severe COVID-19 in people living with HIV. HIV Med. 2021 May;22(5):372-378. doi:10.1111/hiv.13037

Sharov KS. HIV/SARS-CoV-2 co-infection: T cell profile, cytokine dynamics and role of exhausted lymphocytes. Int J Infect Dis. 2021;102:163-169. doi:10.1016/j.ijid.2020.10.049

Augello M, Bono V, Rovito R, Tincati C, Marchetti G. Immunologic interplay between HIV/AIDS and COVID-19: adding fuel to the flames? Curr HIV/AIDS Rep. 2023;20:51-75. doi:10.1007/s11904-023-00647-z