People living with HIV are still at higher risk of dying from COVID-19 in the Omicron wave

People living with HIV continue to have a higher risk of dying after being hospitalized with COVID-19 and have not experienced the same decline in COVID-related mortality as HIV-negative people during the Omicron wave of the pandemic, according to a research team from World Health Organization (WHO) reported this week at the 24th International AIDS Conference (AIDS 2022).

At last year’s IAS Conference on HIV Science, the same team presented results of a global analysis of data submitted to the WHO Global Clinical Platform on COVID-19, showing that people living with HIV were more likely to be hospitalized with COVID-19 will be 30% more likely to die from COVID-19 after admission.

The updated study, presented this week, analyzed additional data submitted to the clinical platform from 50 countries on people hospitalized with COVID-19 from the start of the pandemic through May 2022. Data on HIV status of hospitalized patients were available for 42 countries covering 362,841 people. Just over 8% (29,530) were living with HIV. 96 percent of the data on people living with HIV came from Africa, mostly from South Africa. This study was not able to collect data on vaccination status or previous COVID-19 disease, so it is not possible to say what impact they had on the results.

Some symptoms were more common in people with HIV than in people who were HIV negative. In order of frequency, fever (66%), shortness of breath (59%), fatigue (41%), headache (31%), chest pain (27%), loss of smell (25%), and myalgia (19%) occurred in humans more common with HIV than in HIV-negative people. However, coughing was slightly less common in people with HIV (47%) than in HIV negative people (53%).

Basic health problems were more common among people living with HIV than among HIV-negative people. Fifty-nine percent of people living with HIV who were hospitalized had at least one underlying medical condition compared to 45% of HIV-negative people (p<0.001), most commonly hypertension (30%), obesity (29%), tuberculosis ( 27%) and diabetes (19%). With the exception of tuberculosis, which was much less common (2%) in HIV-negative people, the prevalence of underlying diseases was similar in HIV-negative people. Seven percent of those infected with HIV had at least three underlying diseases.

In the updated analysis, people living with HIV had a 51% increased risk of dying after being hospitalized with COVID-19, a slightly higher rate than previously reported.

Analysis by CD4 count (above or below 200) and viral load (above or below 1000) showed that a CD4 count below 200 and a viral load above 1000 doubled the risk of dying after hospital admission, adjusted for age, sex and Co-morbidities (adjusted hazard ratio 1.96, 95% CI 1.81-2.12) compared to HIV-negative individuals. People living with HIV with CD4 counts below 200 and suppressed viral load (< 1000 copies/mL) had a 62% greater risk of death (aHR 1.62, 95% CI 1.52-1.73).

A CD4 count above 200 and unsuppressed viral load was associated with a 29% increased risk of death, while a CD4 count above 200 and suppressed viral load was associated with a 12% increased risk of death.

“The study results underscore the importance of promoting immunization for people living with HIV.”

The WHO researchers also looked at changes in mortality rates over time. In 2020, during the alpha and beta variant waves of the pandemic, 24% of people living with HIV and 21% of HIV-negative people died after being hospitalized with COVID-19. Death rates were also similar in 2021, when alpha, beta, and delta variants predominated (24% and 22%, respectively). But in 2022, when the Omicron variant replaced earlier variants, fatality rates diverged. While the mortality rate after hospitalization for HIV-negative people has fallen to 8% year-to-date, the mortality rate for people living with HIV remains close to 20% (19.8%).

When they compared death rates between the Delta Wave (August to October 2021) and the Omicron Wave (November 2021 to May 2022) in South Africa, the researchers found that people living with HIV were 55% more likely to die during the Delta Wave died (aHR 1.55), they were more than twice as likely to die during the Omicron wave (aHR 2.47).

dr WHO’s Silvia Bertagnolio said the persistently high mortality rate among people living with HIV also likely reflects the low vaccination coverage in the country providing the most data. By the end of 2021, 27% of South Africans had been vaccinated against COVID-19 and vaccination coverage is now estimated at 32%. Bertagnolio said immunization coverage is still unacceptably low in sub-Saharan Africa, where 18% of the population has been vaccinated, compared to a global average of 62%.

She said the study results underscore the importance of improving access to vaccination, promoting immunization for people living with HIV and making COVID-19 antiviral drugs available to people living with HIV to reduce the risk of severe consequences.

She also stressed the importance of minimizing exposure to COVID-19 in people living with HIV, particularly those with CD4 counts below 200 or comorbidities, and ensuring uninterrupted antiretroviral treatment.

Lower CD4 count associated with infection

Preliminary results from the Ubuntu mRNA SARS-CoV-2 vaccination study in South Africa, presented as a late outbreak on the last day of AIDS 2022, underscored the importance of minimizing SARS-CoV-2 exposure in people living with HIV.

Baseline screening results from the study, which tested participants for the virus prior to vaccination, showed that 31% of study participants screened in November and December 2021 at the start of the Omicron variant wave tested positive for SARS-CoV. 2 PCR tests.

Between November 2021 and July 2022, 8% of people living with HIV without prior SARS-CoV-2 disease at baseline had asymptomatic SARS-CoV-2. The risk of asymptomatic infection was higher in people with no history of SARS-CoV-2.

People living with HIV with lower CD4 counts had a higher risk of being diagnosed with SARS-CoV-2 at baseline after adjusting for prior exposure, sex assigned at birth and trend over time. Every tenfold increase in CD4 count was associated with a doubling of the risk of a positive result. A person with a CD4 count of 50 had about a 50 percent chance of testing positive at baseline screening in December 2021, compared to a 25 percent chance for people with a CD4 count of about 500.

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