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

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