A multi-clinic study of HIV and COVID-19 in the U.S.

A team of researchers, with the help of a computer network, analysed the medical records of 50 million people in the United States. The team focused on 50,167 people with COVID-19, 404 of whom were co-infected with HIV.

A summary of key features of the HIV-positive population was as follows:

  • 71% men, 29% women
  • age – 48 years
  • major ethno-racial groups: black – 50%; white – 34%; Hispanic – 13%;
    Asian – 2%

The overall distribution of major underlying health conditions was as follows:

Higher-than-normal blood pressure

  • HIV-positive people – 46%
  • HIV-negative people – 28%

Chronic lung disease

  • HIV-positive people – 25%
  • HIV-negative people – 16%

Chronic kidney disease

  • HIV-positive people – 17%
  • HIV-negative people – 7%

History of nicotine dependence

  • HIV-positive people – 14%
  • HIV-negative people – 7%


  • HIV-positive people – 26%
  • HIV-negative people – 21%

Type 2 diabetes

  • HIV-positive people – 22%
  • HIV-negative people – 15%

Coronary artery disease

  • HIV-positive people – 14%
  • HIV-negative people – 8%

Clinical outcomes – 28 days later

Twenty-eight days after COVID-19 diagnosis, researchers compared the proportions of people who died. At first, it seemed that HIV-positive people were more likely to die than HIV-negative people. However, after researchers matched each HIV-positive person with an HIV-negative person of the same age and gender, there were no statistically significant differences in survival between the two groups. Among HIV-positive people, there was no increased risk of death whether or not people were on ART.

However, the researchers did find that more HIV-positive people (19%) required hospitalization than HIV-negative people (11%).

Lab tests

Lab test results on blood samples for proteins that are elevated during inflammatory conditions were not different between HIV-positive and HIV-negative people with COVID-19. These blood tests assessed levels of the following proteins:

  • C-reactive protein (CRP)
  • ferritin
  • ESR (erythrocyte sedimentation rate)
  • lactate dehydrogenase

Bear in mind

This is one of the largest formal comparative studies of COVID-19 in HIV-positive and HIV-negative people from a high-income country published so far. Although it found that comorbidities (underlying health conditions) are relatively common among HIV-positive people, which has been reported in smaller studies, a greater prevalence of comorbidities did not lead to an increased risk of death.

Like many other studies reported in this issue of TreatmentUpdate, these findings should be treated as exploratory until results from a much larger group of HIV-positive people with COVID-19 can be obtained. The present study is based on limited analysis from a database that appeared to lack detailed immunological and virological data related to HIV care. Despite these caveats, the study is a useful and necessary step in understanding the impact of COVID-19 on the health of HIV-positive people. As well, it shows that research can be done in the face of a major pandemic.

—Sean R. Hosein


Hadi YB, Naqvi SFZ, Kupec JT, Sarwari AR. Characteristics and outcomes of COVID-19 in patients with HIV: a multicentre research network study. AIDS. 2020 Nov 1;34(13):F3-F8.