COVID-19 Susceptibility and Outcomes Among People Living With HIV in San Francisco

Darpun Sachdev, MD; Elise Mara, MPH; Ling Hsu, MPH; Susan Scheer, PhD, MPH; George Rutherford, MD; Wayne Enanoria, PhD, MPH; Monica Gandhi, MD, MPH


J Acquir Immune Defic Syndr. 2021;86(1):19-21. 

In This Article


Among 4252 COVID-19 tests performed among PLWH from March 24, 2020, to September 3, 2020, 4.5% (N = 193) were positive for COVID-19. This compares with a 3.5% (N = 9626) positivity rate among the 272,555 people without HIV who were tested for COVID-19 by that date. The proportion of PLWH who tested positive was significantly higher than people without HIV (2 tailed z-test 3.52, P = 0.00004).

Among all persons coinfected with HIV and COVID-19, the mean age was 48 years (interquartile range, 37–57), 38.9% White, 38.3% Latinx, 11.9% Black, 6.7% Asian, 91.2% were men, 6.2% women, and 2.6% transgender women (Table 1). Thirty (15.5%) of these PLWH who tested positive for COVID-19 were part of an outbreak investigation in congregate living situations, such as a homeless shelter.[12] Of the PLWH with COVID-19, 68.9% were diagnosed with HIV before 2010, and 44% were virally suppressed at their most recent laboratory test. At the last CD4 count result, 121 (62.7%) had a CD4 count >500 cells/mm,[3] 60 (31.1%) had a CD4 count of 200–500, and 12 (6.2%) had a CD4 count <200.

Of the 193 persons coinfected with COVID-19 and HIV, 183 (94.8%) were interviewed by a case investigator at the time of their COVID-19 diagnosis (Table 1). Of these, only 100 (54.6%) were housed, and the others likely experienced marginal housing: 6 (3.3%) lived in a long-term care facility or residential care facility, 5 (2.7%) stayed in a shelter, 13 (7.1%) lived in a single room occupancy hotel, 6 were experiencing street homelessness, and 52 (28.4%) stated they were not housed but did not further specify. Of the 183 interviewed, 24% reported known contact with someone diagnosed with COVID-19, and 42.6% reported an additional risk factor for COVID-19 disease severity (7.1% cardiovascular disease, 4.9% diabetes, 1.6% liver, and 4.4% lung disease, Table 2). In addition, 9.3% were current smokers, and 10.9% were former smokers. Only 60.7% reported COVID-19 symptoms at interview; the most frequently reported were cough (38.8%), fever (33.9%), rhinorrhea (25.7%), myalgias (28.4%), headache (26.8%), chills (21.9%), shortness of breath (15.3%), sore throat (15.3%), and loss of taste/smell (19.1%). Only 7.7% required hospitalization, and only 2 patients required admission to the intensive care unit. None of the HIV/COVID-19 coinfected patients died.