A new World Health Organization (WHO) report confirms that HIV infection is a significant independent risk factor for both severe/critical COVID-19 presentation at hospital admission and in-hospital mortality.

Overall, nearly a quarter (23.1 per cent) of all people living with HIV who were hospitalised with COVID-19 died, a release from the WHO said.

The report is based on clinical surveillance data from 37 countries regarding the risk of poor COVID-19 outcomes in people living with HIV (PLHIV) admitted to hospital for COVID-19.

It found that the risk of developing severe or fatal COVID-19 was 30 per cent greater in PLHIV compared to people without HIV infection. Underlying conditions such as diabetes and hypertension are common among PLHIV. Among male PLHIV over the age of 65 years, diabetes and hypertension were associated with an increased risk of more severe and fatal COVID-19. These conditions are known to put people at increased risk of severe disease and death, the release said.

This highlights the need for PLHIV to stay as healthy as possible, regularly access and take their ARV medications, and prevent and manage underlying conditions, WHO said. This also means that people living with HIV — independent of their immune status — should be prioritised for vaccination in most settings. An informal WHO poll revealed that out of 100 countries with information, 40 countries have prioritised PLHIV for COVID-19 vaccination.

The analysis is informed by data from WHO’s Global Clinical Data Platform for COVID-19, which collects individual-level clinical data and characterises COVID-19 among individuals hospitalised with suspected or confirmed SARS-CoV-2 infection around the globe.

Last Friday WHO also released updated guidelines on HIV prevention, testing, treatment, service delivery and monitoring. These guidelines provide more than 200 evidence-informed recommendations and good practice statements for a public health response to the prevention, testing, and treatment of people living with HIV. WHO said these recommendations help to ensure that people with HIV can start and continue treatment during times of service disruption as a consequence of the novel coronavirus pandemic.

“The report… will have important policy implications — providing data to confirm that HIV poses a risk for poor outcomes from COVID-19 — and increases the urgency to see all PLHIV on treatment and with access to COVID-19 vaccinations,” said Dr Meg Doherty, director of WHO’s Department of Global HIV, Hepatitis and STI Programmes.

HIV continues to be a major global public health issue, having claimed 34.7 million lives so far. To reach the new proposed global 95–95–95 targets set by UNAIDS, countries need to redouble efforts to avoid increasing HIV infections due to HIV service disruptions during COVID-19, thereby slowing down the public health response to HIV.