Description of COVID-19 in HIV-infected individuals: a single-centre, prospective cohort

Lancet HIV. 2020 Aug;7(8):e554-e564. doi: 10.1016/S2352-3018(20)30164-8. Epub 2020 May 28.


Background: Information about incidence, clinical characteristics, and outcomes of HIV-infected individuals with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is scarce. We characterised individuals with COVID-19 among a cohort of HIV-infected adults in Madrid.

Methods: In this observational prospective study, we included all consecutive HIV-infected individuals (aged ≥18 years) who had suspected or confirmed COVID-19 as of April 30, 2020, at the Hospital Universitario Ramón y Cajal (Madrid, Spain). We compared the characteristics of HIV-infected individuals with COVID-19 with a sample of HIV-infected individuals assessed before the COVID-19 pandemic, and described the outcomes of individuals with COVID-19.

Findings: 51 HIV-infected individuals were diagnosed with COVID-19 (incidence 1·8%, 95% CI 1·3-2·3). Mean age of patients was 53·3 years (SD 9·5); eight (16%) were women, and 43 (84%) men. 35 (69%) cases of co-infection had laboratory confirmed COVID-19, and 28 (55%) required hospital admission. Age and CD4 cell counts in 51 patients diagnosed with COVID-19 were similar to those in 1288 HIV-infected individuals without; however, 32 (63%) with COVID-19 had at least one comorbidity (mostly hypertension and diabetes) compared with 495 (38%) without COVID-19 (p=0·00059). 37 (73%) patients had received tenofovir before COVID-19 diagnosis compared with 487 (38%) of those without COVID-19 (p=0·0036); 11 (22%) in the COVID-19 group had previous protease inhibitor use (mostly darunavir) compared with 175 (14%; p=0·578). Clinical, analytical, and radiological presentation of COVID-19 in HIV-infected individuals was similar to that described in the general population. Six (12%) individuals were critically ill, two of whom had CD4 counts of less than 200 cells per μL, and two (4%) died. SARS-CoV-2 RT-PCR remained positive after a median of 40 days from symptoms onset in six (32%) individuals, four of whom had severe disease or low nadir CD4 cell counts.

Interpretation: HIV-infected individuals should not be considered to be protected from SARS-CoV-2 infection or to have lower risk of severe disease. Generally, they should receive the same treatment approach applied to the general population.

Funding: None.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Anti-HIV Agents / therapeutic use
  • Body Mass Index
  • CD4 Lymphocyte Count
  • COVID-19
  • Comorbidity
  • Coronavirus Infections / complications*
  • Coronavirus Infections / drug therapy
  • Coronavirus Infections / epidemiology*
  • Female
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • Humans
  • Incidence
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / drug therapy
  • Pneumonia, Viral / epidemiology*
  • Prospective Studies
  • Spain / epidemiology
  • Tenofovir / therapeutic use
  • Young Adult


  • Anti-HIV Agents
  • Tenofovir