COVID-19 Testing, Characteristics, and Outcomes Among People Living With HIV in an Integrated Health System

Jennifer J. Chang, MD; Katia Bruxvoort, PhD; Lie H. Chen, DrPH; Bobak Akhavan, MD; Janelle Rodriguez, MD; Rulin C. Hechter, PhD


J Acquir Immune Defic Syndr. 2021;88(1):1-5. 

In This Article


The COVID-19 pandemic has resulted in significant morbidity and mortality, with at least 122 million cases confirmed and more than 2.7 million deaths worldwide, as of March 21, 2021.[1] More than 542,000 deaths have been reported in the United States.[2] Major risk factors for poor outcomes associated with COVID-19 include older age and preexisting underlying medical conditions such as diabetes mellitus,[3] obesity,[4] cardiovascular disease,[5] and chronic kidney disease.[6]

Limited reports on the characteristics and outcomes of SARS-CoV-2 infection and subsequent COVID-19 disease in people living with HIV (PLWH) have been published through several case series.[7–17] One case series of PLWH in New York City reported a particularly high mortality rate (19/72 or 26% of cases) after COVID-19 hospitalization.[14] Two studies reported no significant differences among hospitalized PLWH matched with hospitalized HIV-negative patients in COVID-19 disease severity as measured by intubation and death.[15,16] Understanding risk factors underlying COVID-19 clinical severity among PLWH is critical for risk stratification and treatment strategies in this population. Modern antiretroviral therapy to treat HIV infection has enabled PLWH who are virally suppressed to significantly extend life expectancy. Within the Kaiser Permanente system, an 8-year life expectancy gap persists.[18] Comorbidities associated with antiretroviral therapy or underlying chronic inflammation in well-controlled HIV may predispose PLWH to more severe COVID-19 outcomes.

In this study, we have described the incidence of testing, diagnosis, and hospitalization for COVID-19 among PLWH and HIV-uninfected patients in a large integrated health care system in California.