BACKGROUND: There is limited data on the impact of SARS-CoV-2 variants on mortality among people living with HIV (PLHIV). We investigated changes in in-hospital mortality during the different SARS-CoV-2 variant waves.
METHODS: Method: We analyzed individual-level data from the WHO Global Clinical Platform comprising 821,331 hospitalized children and adults from 42 countries. We used Cox regression to evaluate association of HIV co-infection with in-hospital mortality across SARS-CoV-2 pre-Delta, Delta and Omicron variant waves and to assess risk factors for mortality among PLHIV.
RESULTS: PLHIV had a 54% (aHR 1.54, 95%CI 1.42-1.68) higher risk of death during the pre-Delta variant wave, 56% (aHR 1.56, 95%CI 1.40-1.74) during Delta variant wave and 142% (aHR 2.42, 95%CI 2.11-2.78) during Omicron variant wave compared to HIV negative populations, with the risk being higher among those with CD4=200 cells/mm3. While the mortality rate among HIV negative population declined from 21% (Delta wave) to 7.9% (Omicron wave), the reduction among PLHIV was only modest (from 25% to 18%). Reduction in mortality was even less apparent for PLHIV with CD4<200 cells/mm3. People with unknown HIV status also had a higher risk of death across the three waves. Common risk factors for mortality across the three SARS-COV-2 variant waves among PLHIV were severe/critical COVID-19 at admission and CD4 =200 cells/mm3. PLHIV with at least one dose of COVID-19 vaccination had 39% (aHR 0.61, 95%CI 0.40-0.92) lower risk of death during the Delta variant wave and 38% (aHR 0.62, 95%CI 0.45-0.85) during the Omicron variant wave compared to the unvaccinated.
CONCLUSIONS: While the mortality risk among HIV negative people decreased drastically in the omicron wave, only a modest reduction was observed in PLHIV, and especially in those with low CD4, resulting in a relatively greater hazard for PLHIV. The observed high risk of death among COVID-19 patients with unknown HIV status calls for the need to intensify HIV testing and treatment as PLHIV who are unaware of their serologic status may be at risk of worse outcomes during the pandemic. These findings highlight the need to implement WHO guidelines recommending booster vaccine for populations most-at-risk of severe COVID-19 outcomes, including in PLHIV.