Background HIV infection causes immune dysregulation affecting T-cell and monocyte function, which may alter coronavirus disease 2019 (COVID-19) pathophysiology. Objectives We investigated the associations among clinical phenotypes, laboratory biomarkers, and hospitalisation outcomes in a cohort of people hospitalised with COVID-19 in a high HIV prevalence area. Method We conducted a prospective observational cohort study in Tshwane, South Africa. Respiratory disease severity was quantified using the respiratory oxygenation score. Analysed biomarkers included inflammatory and coagulation biomarkers, CD4 T-cell counts, and HIV-1 viral loads (HIVVL). Results The analysis included 558 patients, of whom 21.7% died during admission. The mean age was 54 years. A total of 82 participants were HIV-positive. People living with HIV (PLWH) were younger (mean age 46 years) than HIV-negative people; most were on antiretroviral treatment with a suppressed HIVVL (72%) and the median CD4 count was 159 (interquartile range: 66-397) cells/µL. After adjusting for age, HIV was not associated with increased risk of mortality during hospitalisation (age-adjusted hazard ratio = 1.1, 95% confidence interval: 0.6-2.0). Inflammatory biomarker levels were similar in PLWH and HIV-negative patients. Detectable HIVVL was associated with less severe respiratory disease. In PLWH, mortality was associated with higher levels of inflammatory biomarkers. Opportunistic infections, and other risk factors for severe COVID-19, were common in PLWH who died. Conclusion PLWH were not at increased risk of mortality and those with detectable HIVVL had less severe respiratory disease than those with suppressed HIVVL. What this study adds This study advances our understanding of severe COVID-19 in PLWH.

中文翻译：

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HIV 高流行地区的 COVID-19 严重程度和院内死亡率。

背景 HIV 感染导致影响 T 细胞和单核细胞功能的免疫失调，这可能会改变 2019 冠状病毒病 (COVID-19) 的病理生理学。目标 我们调查了在 HIV 高流行地区住院的 COVID-19 患者队列中临床表型、实验室生物标志物和住院结果之间的关联。方法 我们在南非茨瓦内进行了一项前瞻性观察队列研究。使用呼吸氧合评分量化呼吸系统疾病的严重程度。分析的生物标志物包括炎症和凝血生物标志物、CD4 T 细胞计数和 HIV-1 病毒载量 (HIVVL)。结果 分析包括 558 名患者，其中 21.7% 在入院期间死亡。平均年龄为 54 岁。共有 82 名参与者为 HIV 阳性。HIV 感染者 (PLWH) 比 HIV 阴性者更年轻（平均年龄 46 岁）；大多数接受抗逆转录病毒治疗，HIVVL (72%) 受到抑制，CD4 计数中位数为 159（四分位间距：66-397）细胞/µL。调整年龄后，HIV 与住院期间死亡风险增加无关（年龄调整风险比 = 1.1，95% 置信区间：0.6-2.0）。PLWH 和 HIV 阴性患者的炎症生物标志物水平相似。可检测到的 HIVVL 与不太严重的呼吸道疾病有关。在 PLWH 中，死亡率与较高水平的炎症生物标志物相关。机会性感染和严重 COVID-19 的其他危险因素在死亡的 PLWH 中很常见。结论 PLWH 的死亡风险并未增加，并且与 HIVVL 受到抑制的患者相比，可检测到 HIVVL 的患者的呼吸系统疾病严重程度较低。这项研究增加了什么这项研究促进了我们对 PLWH 中严重 COVID-19 的理解。