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


Incidence of Testing, Diagnosis, and Hospitalization in PLWH and HIV-uninfected Patients

The underlying study population included 10,702 PLWH and 3,739,207 HIV-uninfected individuals (Table 1) who were KPSC health plan members between March 1, 2020, and May 31, 2020. Incidence of SARS-CoV-2 molecular testing, COVID-19 diagnosis, and COVID-19 hospitalization was 551.2, 57.0, and 9.3 per 10,000 PLWH compared with 268.4, 34.6, and 5.3 per 10,000 HIV-uninfected individuals, respectively. We observed tests with positive results for 47 PLWH (10.3%) of 590 tested PLWH and 9918 (12.9%) of 100,363 tested HIV-uninfected individuals; an additional 14 PLWH and 3003 HIV-uninfected individuals had clinical diagnoses only, yielding a total of 61 COVID-19 cases among PLWH and 12,921 COVID-19 cases among HIV-uninfected individuals (Table 1). Ten (16.3%) PLWH were hospitalized with COVID-19, 5 (8.2%) were admitted to the intensive care unit (ICU), 3 (4.9%) required invasive mechanical ventilation, and 1 (1.6%) died from COVID-19. In comparison, for HIV-uninfected patients, 1975 (15.3%) were hospitalized, 494 (3.8%) were admitted to ICU, 444 (3.4%) required invasive mechanical ventilation, and 300 (2.3%) died from COVID-19 (Table 1).

Baseline Characteristics of PLWH and HIV-uninfected Patients

PLWH with COVID-19 were younger than HIV-uninfected individuals with COVID-19 (20.0% vs. 46.8% aged 60 years or older, respectively, for hospitalized cases and 3.9% vs. 19.3% aged ≥60 years or older, respectively, for nonhospitalized cases). PLWH were predominantly men, whereas 53.2% of hospitalized and 42.7% of nonhospitalized HIV-uninfected patients with COVID-19 were men. Slightly higher proportions of hospitalized and nonhospitalized PLWH were White compared with HIV-uninfected individuals (Table 2).

BMI, smoking status, and comorbid conditions did not differ significantly between PLWH and HIV-uninfected individuals for hospitalized and nonhospitalized cases (Table 2). Previous year emergency department and hospitalization utilization was also similar for PLWH and HIV-uninfected individuals who were hospitalized or nonhospitalized.

Exposure History, Symptoms, and Clinical Characteristics of COVID-19 in PLWH

A manual chart review was conducted for 61 PLWH with COVID-19 diagnoses. Of them, 4 were considered not to have COVID-19 based on the chart review; 3 individuals were asymptomatic and showed negative results for SARS-CoV-2 RT-PCR test, and 1 individual had a clinical diagnosis only with no indication of COVID-19 symptoms or testing on the manual chart review. Of the remaining 57 COVID-19 cases, 10 were clinically diagnosed, and 8 of these cases had documentation of a test with positive result outside KPSC.

Among PLWH with COVID-19, last recorded HIV-1 quantitative viral load demonstrated that ≥95% achieved viral suppression in both hospitalized (n = 10, 100.0%) and nonhospitalized patients (n = 47, 95.7%). There were no significant differences in recent CD4+ levels within the previous year between hospitalized and nonhospitalized patients (P = 0.168).

The most common presenting symptoms in PLWH with COVID-19 were cough (n = 44, 77.2%), fever (n = 38, 66.7%), and shortness of breath (n = 24, 42.1%). Nine of 57 (15.8%) PLWH were workers in health care settings; of them, 3 (5.2%) worked in long-term care facilities. By exposure history, in 28 (49.1%) cases, no known exposures were documented. Eleven (19.2%) patients reported at least 1 household contact showing a positive result for COVID-19. Thirteen (22.8%) patients reported exposure to community members outside their home with a COVID-19 diagnosis. Six (10.5%) patients reported exposure to colleagues or patients with COVID-19.

Treatment and Complications of COVID-19 in PLWH

Substantial variability in treatment patterns existed within the KPSC system for COVID-19 because of evolving practice guidelines and a lack of evidence-based treatment within the study period. The most commonly prescribed antiinfective drugs were antibiotics. Hydroxychloroquine was prescribed to more than half (n = 6, 60%) of the hospitalized patients. Three of the 10 (30.0%) hospitalized patients received remdesivir.

Two patients who were hospitalized developed methicillin-susceptible Staphylococcus aureus hospital-acquired pneumonia during hospitalization. No patients who survived hospitalization developed myocardial infarction, thromboembolism, other vascular complications, or death within 30 days of discharge.