SARS-CoV-2 testing, positivity, and factors associated with COVID-19 among people with HIV across Europe in the multinational EuroSIDA cohort. HIV Medicine
Fursa et al. on behalf of the EuroSIDA cohort investigated SARS-CoV-2 testing positivity and hospital admissions in a large prospective cohort of people with HIV in Europe between 1 January 2020 and 31 December 2021 and looked at inter-regional differences in SARS-CoV-2 testing.
Of 9’012 participants, 2’270 (25.2%, 95% confidence interval [CI] 24.3–26.1) had a SARS-CoV-2 polymerase chain reaction test during the study period (range: 38.3% in Northern to 14.6% in Central-Eastern Europe). People from Northern Europe, women, those aged <40 years, those with CD4 cell count<350 cells/mm3, and those with previous cardiovascular disease or malignancy were significantly more likely to have been tested, as were people with HIV in 2021 compared with those in 2020. Overall, 390 people with HIV (4.3%, 95% CI3.9–4.8) tested positive (range: 2.6% in Northern to 7.1% in Southern Europe), and the odds of testing positive were higher in all regions than in Northern Europe and in 2021 than in 2020. In total, 64 people with HIV (0.7%, 95% CI0.6–0.9) were hospitalized, of whom 12 died. Compared with 2020, the odds of positive testing decreased in all regions in 2021, and the associations with cardiovascular disease, malignancy, and use of tenofovir disoproxil fumarate disappeared in 2021. Among study participants, 58.9% received a COVID-19 vaccine (range: 72.0% in Southern to 14.8% in Eastern Europe).
In conclusion, the study demonstrated a high variability in SARS-CoV-2 testing and positive test results in people with HIV across regions of Europe, whereas the proportion of severe COVID-19 was consistent across regions and the proportion of deaths was lower than that in the general population. The EuroSIDA region was the strongest factor associated with SARS-CoV-2 testing, suggesting the need to address the large inter-regional disparity in testing in a population that remains vulnerable to COVID-19. Female sex, younger age, and prior CVD and malignancy were associated with a higher likelihood of being tested, whereas TDF use was negatively associated with testing positive in 2020 but not in 2021. The changes in the associations in 2021, along with the decline in the proportion of admissions due to COVID-19 in the regions with better vaccine coverage, highlight the importance of SARS-CoV-2 vaccine provision to protect people eat risk.