Immune deficiency is a risk factor for severe COVID-19 in people living with HIV

HIV Med. 2021 May;22(5):372-378. doi: 10.1111/hiv.13037. Epub 2020 Dec 27.


Objectives: A prior T cell depletion induced by HIV infection may carry deleterious consequences in the current COVID-19 pandemic. Clinical data on patients co-infected with HIV and SARS-CoV-2 are still scarce.

Methods: This multicentre cohort study evaluated risk factors for morbidity and mortality of COVID-19 in people living with HIV (PLWH), infected with SARS-CoV-2 in three countries in different clinical settings. COVID-19 was clinically classified as to be mild-to-moderate or severe.

Results: Of 175 patients, 49 (28%) had severe COVID-19 and 7 (4%) patients died. Almost all patients were on antiretroviral therapy (ART) and in 94%, HIV RNA was below 50 copies/mL prior to COVID-19 diagnosis. In the univariate analysis, an age 50 years or older, a CD4+ T cell nadir of < 200/µl, current CD4+ T cells < 350/µl and the presence of at least one comorbidity were significantly associated with severity of COVID-19. No significant association was found for gender, ethnicity, obesity, a detectable HIV RNA, a prior AIDS-defining illness, or tenofovir (which was mainly given as alafenamide) or protease inhibitor use in the current ART. In a multivariate analysis, the only factor associated with risk for severe COVID-19 was a current CD4+ T cell count of < 350/µl (adjusted odds ratio 2.85, 95% confidence interval 1.26-6.44, p=0.01). The only factor associated with mortality was a low CD4 T cell nadir.

Conclusions: In PLWH, immune deficiency is a possible risk factor for severe COVID-19, even in the setting of virological suppression. There is no evidence for a protective effect of PIs or tenofovir alafenamide.

Keywords: COVID-19; HIV infection; SARS-CoV-2; antiretroviral therapy; immune deficiency.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Antiretroviral Therapy, Highly Active / methods*
  • CD4-Positive T-Lymphocytes / metabolism*
  • COVID-19 / immunology
  • COVID-19 / mortality*
  • Cohort Studies
  • Coinfection
  • Germany / epidemiology
  • HIV Infections / drug therapy*
  • HIV Infections / immunology
  • HIV Infections / mortality
  • Humans
  • Italy / epidemiology
  • Middle Aged
  • RNA, Viral / genetics
  • Risk Assessment
  • Severity of Illness Index
  • Spain / epidemiology
  • Viral Load
  • Young Adult


  • RNA, Viral