Factors Associated With Severity of COVID-19 Disease in a Multicenter Cohort of People With HIV in the United States, March–December 2020

Adrienne E. Shapiro, MD, PhD; Rachel A. Bender Ignacio, MD, MPH; Bridget M. Whitney, PhD; Joseph A. Delaney, PhD; Robin M. Nance, MS; Laura Bamford, MD, MSCE; Darcy Wooten, MD, MS; Jeanne C. Keruly, MS, CRNP; Greer Burkholder, MD, MSPH; Sonia Napravnik, PhD; Kenneth H. Mayer, MD; Allison R. Webel, RN, PhD; H. Nina Kim, MD, MSc; Stephen E. Van Rompaey, PhD; Katerina Christopoulos, MD, MPH; Jeffrey Jacobson, MD; Maile Karris, MD; Davey Smith, MD, MAS; Mallory O. Johnson, PhD; Amanda Willig, RD, PhD; Joseph J. Eron, MD, MPH; Peter Hunt, MD; Richard D. Moore, MD, MHS; Michael S. Saag, MD; W. Christopher Mathews, MD, MSPH; Heidi M. Crane, MD, MPH; Edward R. Cachay, MD, MAS; Mari M. Kitahata, MD, MPH


J Acquir Immune Defic Syndr. 2022;90(4):369-376. 

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Given the experience of many long-term survivors living through the first 2 decades of the AIDS epidemic, the isolation, scientific uncertainty, and lack of actionable medical interventions have revived many parallel concerns for PWH.[17,54,55] Developing clear understanding of whom among those with HIV is at an increased risk for severe outcomes with this new pathogen, and which risks are modifiable, can mitigate both the medical and psychological burden to PWH during this pandemic. Results of this large multisite cohort study demonstrate that older PWH with a CD4 cell count <350 cells/mm3 or historic CD4 counts <200 cells/mm3 have a higher risk of severe COVID-19 disease. Comorbidities including CKD, liver fibrosis, COPD, diabetes, hypertension, obesity, and cardiovascular risk also impart an increased risk of severe COVID-19 in PWH. PWH with these risk factors should be strongly encouraged to receive preventive vaccines and boosters and should be prioritized for allocation of early therapeutics such as monoclonal antibodies.