Researchers led by the London School of Hygiene & Tropical Medicine have concluded that people with HIV may be at increased risk of COVID-19 mortality.
Working on behalf of NHS England, the team did a retrospective cohort study using the OpenSAFELY platform to analyse routinely collected primary care data linked to national death registrations. People with a primary care record of HIV infection were compared with people without HIV.
In total, 17,282,905 adults were included, of whom 27,480 (0.16%) had a recorded HIV diagnosis. People living with HIV were more likely to be male, of black ethnicity and from a more deprived geographical area than the general population.
During the study period, 14,882 COVID-19 deaths occurred, with 25 among people with HIV. People living with HIV had higher risk of COVID-19 death than those without HIV after adjusting for age and sex (HR, 2.90; 95% CI, 1.96-4.30; P<.0001).
The association was attenuated after adjustment for deprivation, ethnicity, smoking and obesity, but the risk remained high (aHR, 2.59; 95% CI, 1.74-3.84; P<.0001).
There was some evidence that the association was larger among people of black ethnicity (HR, 4.31; 95% CI. 2.42-7.65) versus 1.84 (95% CI, 1.03-3.26) in non-black individuals (Pinteraction=.044).
The authors concluded that people in the UK with HIV seem to be at increased risk of COVID-19 mortality. They say targeted policies should be considered to address this raised risk as the pandemic response evolves.
However, in a linked editorial, Chair of the British HIV Association, Laura J Waters and Anton L Pozniak from the Department Clinical Research at the London School of Hygiene & Tropical Medicine advise caution in interpreting the findings.
They say the statement that HIV was associated with increased risk of COVID-19 mortality might overshadow the other findings of a low absolute mortality of less than 0.1 per cent and that 23 (92%) of 25 people with HIV who died had comorbidities. The remaining two (8%) were not at increased risk of death.
“An interpretation of this study that might better serve people living with HIV in the UK and the clinicians that treat them is that their findings are important, but their conclusion should be taken with caution until we have more specific controlled data to assess the effects of HIV on COVID-19 outcomes,” they write.
