The findings are published as a pre-print article at MedRxiv and have not been peer reviewed.
Studies in various countries have produced conflicting evidence about COVID-19 risks in people with HIV:
The analysis covers all cases of COVID-19 diagnosed between 1 March and 7 June 2020. During the study period, 375,260 cases of COVID-19 were diagnosed in people without HIV (a rate of 19.4 per 1,000 people) and 2,988 in people with diagnosed HIV infection (a rate of 27.65 per 1,000). After adjusting for age, sex and region, there was no significant difference in the rate of diagnosis between people with HIV and others (adjusted rate ratio 0.94 [0.91-0.97]).
The rates of hospitalization and death in hospital from COVID-19 were higher in people with diagnosed HIV. Almost 900 people with HIV were admitted to hospital with COVID-19 in the state up to 7 June and people with HIV were significantly more likely to hospitalised due to COVID-19 after adjusting for age, sex and location (adjusted RR 1.38 [1.29-1.47]).
Two hundred and seven people with HIV died of COVID-19 in hospital; people with HIV were more likely to die in hospital with COVID-19 after adjusting for age, sex and location (RR 1.23 [1.07-1.40]). To put the 207 deaths in context, in the same time period in 2019, 490 people with HIV died in the state.
However, this death rate includes people hospitalized for other reasons who died in hospital with a COVID-19 diagnosis. Using a stricter definition – deaths from COVID-19 among people admitted to hospital with a COVID-19 diagnosis – the researchers found no difference in the death rate between people with HIV and people without.
Among people with HIV, the rates of COVID-19 diagnosis, hospitalisation or death did not differ according to transmission category or sex. As in the general population, rates of hospitalization and death were higher in older age groups. Compared to white non-Hispanics, Black and Hispanic people were at higher risk of being diagnosed with COVID-19 but not of hospitalization or death.
The study also looked at the rates of diagnosis, hospitalization and death in hospital among people with diagnosed HIV infection according to CDC disease stage and viral load.
The researchers conclude that in New York state, people living with HIV were not diagnosed with COVID-19 at a higher rate than the rest of the population and did not die at a higher rate if admitted to hospital. But people with HIV were more likely to be admitted to hospital and people with low CD4 counts or unsuppressed viral load were especially likely to be hospitalized.
The study investigators stress that their ability to interpret the results is limited by a lack of information about comorbidities, socio-economic factors and risk factors for COVID-19 exposure. They say more research is needed to understand how these factors affect COVID-19 in people living with HIV.