Research finds people diagnosed with HIV in New York State were more than twice as likely to die from COVID-19

ALBANY, N.Y. (Feb 3, 2021) – New research out of the University at Albany School of Public Health and the AIDS Institute at the New York State Department of Health examined the relationship between HIV infection and COVID-19 – finding that through the middle of 2020, people diagnosed with HIV infection were significantly more likely to contract, be hospitalized with and die from COVID-19.

More than one million people in the U.S. are diagnosed with HIV, with more than 100,000 living in New York State. According to Eli Rosenberg, associate professor of Epidemiology and Biostatistics, because HIV infection weakens the immune system and is associated with a variety of comorbidities, people living with HIV may be more vulnerable to COVID-19.

Published in JAMA Network Open, the researchers from both institutions merged statewide databases for HIV surveillance, COVID-19 diagnoses and COVID-19 hospitalizations. They then compared rates of COVID-19 diagnosis, hospitalization and death between New Yorkers with and without an HIV diagnosis from March to mid-June. Because some increased mortality is a result of people with HIV having risk factors for COVID-19 (such as being male and older), the researchers also conducted an adjusted analysis to understand “how much was due to HIV infection itself,” Rosenberg said.

Results before adjustment include:

• New Yorkers with an HIV diagnosis were 43 percent more likely to be diagnosed with COVID-19 than those without HIV, and 161 percent more likely to be hospitalized with the virus
• HIV patients diagnosed with COVID-19 were 155 percent more likely to die in the hospital of COVID-19 than those without HIV
• One in 522 New Yorkers infected with HIV died in the hospital of COVID-19 from March to mid-June
• Those with more advanced HIV disease (in terms of lower CD4+ T-cell levels, a type of white blood cell typically used as a marker for HIV) faced even greater risks from COVID-19

After adjustment, results indicated that the levels of diagnosis and mortality, given a person was already hospitalized, were not driving disparities in total hospitalizations and deaths. Rather, it was the likelihood of developing severe COVID-19 needing hospitalization, once infected, which appeared to explain elevated levels of hospitalization and death – persons with HIV still had 1.38 times (or 38 percent more) the level of hospitalization compared to those without.   

“New York has long been an epicenter of the HIV epidemic and in the spring became the epicenter of the COVID-19 pandemic,” said Rosenberg. “Data from New York offer an unparalleled opportunity to understand the intersection of the epidemic.”

“The results indicate that prevention and treatment efforts need to give additional consideration and support to the needs and heightened risk of persons living with HIV, including vaccination efforts, when the federal government makes more doses available.” concluded Rosenberg.

Noting that current CDC recommendations are inconclusive about whether HIV infection is considered a qualifying underlying illness for vaccine prioritization, David Holtgrave, dean of the School of Public Health and a researcher on the project, added, “We must ensure that all persons living with HIV are appropriately prioritized and are supported to access safe and highly-efficacious COVID-19 vaccines as soon as supplies become available.”

“As our results clearly establish that more advanced HIV disease is associated with worse COVID-19 outcomes, it is critically important that as soon as additional doses become available from the federal government, people living with HIV have access to and accept vaccination,” said Johanne Morne, Director of the AIDS Institute and study author. “This, along with continued medication adherence and access to HIV care, could help to mitigate the impact of COVID and ensure that the significant progress realized over the last several years towards ending New York State’s HIV epidemic is not lost.”

Citing the evidence of this study, the AIDS Institute’s HIV Clinical Guidelines Committee recently issued a statement outlining the case and recommended practices for vaccination of persons living with HIV.

The study is part of the Center for Collaborative HIV Research in Practice and Policy at the School of Public Health, a research center designed to leverage partnerships with the AIDS Institute and other collaborators to expand collaborations to address social justice and public health challenges of persons at risk for or living with HIV and related diseases.

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