COVID-19 in Hospitalized HIV-Positive and HIV-Negative Patients

A Matched Study

Cristina Díez; Jorge Del Romero-Raposo; Rafael Mican; Juan C. López; José R. Blanco; Sonia Calzado; Gloria Samperiz; Joaquín Portilla; Lucio J. García-Fraile; Félix Gutiérrez; Juan L. Gómez-Sirvent; Inés Suárez-García; Concha Amador; María Novella; Jose R. Arribas; Santiago Moreno; Juan González-García; Inmaculada Jarrín; Juan Berenguer


HIV Medicine. 2021;22(9):867-876. 

In This Article

Abstract and Introduction


Objectives: We compared the characteristics and clinical outcomes of hospitalized individuals with COVID-19 with [people with HIV (PWH)] and without (non-PWH) HIV co-infection in Spain during the first wave of the pandemic.

Methods: This was a retrospective matched cohort study. People with HIV were identified by reviewing clinical records and laboratory registries of 10 922 patients in active-follow-up within the Spanish HIV Research Network (CoRIS) up to 30 June 2020. Each hospitalized PWH was matched with five non-PWH of the same age and sex randomly selected from COVID-19@Spain, a multicentre cohort of 4035 patients hospitalized with confirmed COVID-19. The main outcome was all-cause in-hospital mortality.

Results: Forty-five PWH with PCR-confirmed COVID-19 were identified in CoRIS, 21 of whom were hospitalized. A total of 105 age/sex-matched controls were selected from the COVID-19@Spain cohort. The median age in both groups was 53 (Q1–Q3, 46–56) years, and 90.5% were men. In PWH, 19.1% were injecting drug users, 95.2% were on antiretroviral therapy, 94.4% had HIV-RNA < 50 copies/mL, and the median (Q1–Q3) CD4 count was 595 (349–798) cells/μL. No statistically significant differences were found between PWH and non-PWH in number of comorbidities, presenting signs and symptoms, laboratory parameters, radiology findings and severity scores on admission. Corticosteroids were administered to 33.3% and 27.4% of PWH and non-PWH, respectively (P = 0.580). Deaths during admission were documented in two (9.5%) PWH and 12 (11.4%) non-PWH (P = 0.800).

Conclusions: Our findings suggest that well-controlled HIV infection does not modify the clinical presentation or worsen clinical outcomes of COVID-19 hospitalization.


Since the beginning of the COVID-19 pandemic, HIV has been uncommonly listed as an underlying condition in case series of hospitalized patients with COVID-19.[1,2] This is likely because of the much lower prevalence of HIV among the general population than that of other prevailing diseases and because the number of older individuals is much lower among people with HIV (PWH) than among the HIV-uninfected population (non-PWH). Notwithstanding this, whether HIV increases the risk of acquiring SARS-CoV-2 or the severity or mortality of COVID-19 has stirred substantial research. Many studies have analysed the characteristics and outcomes of COVID-19 in PWH, but to the best of our knowledge, only in eight of these has some comparison been made between PWH and people without HIV (non-PWH).[3–10] In four of these studies, worse outcomes in PWH vs. non-PWH have been reported.[3,7,9,10]

We assessed the frequency of COVID-19 within a large prospective cohort of PWH in Spain during the first wave of the pandemic and compared the characteristics and clinical outcomes of hospitalized PWH with COVID-19 with an age/sex-matched control group of non-PWH.