Covid-19 severity and mortality among hospitalized patients in Zambia

Background: Zambia-where HIV prevalence is 11.5% - is experiencing widespread transmission of COVID-19. Studies of clinical outcomes of COVID-19 among HIV-infected individuals have shown mixed results of the impact of HIV status on disease severity or mortality. However, unlike Zambia, most of these studies originated from countries with low prevalence of HIV, with the HIV-infected individuals comprising a small fraction of the overall COVID-19 patient population. We describe the clinical outcomes of patients with SARSCoV2 infections who were admitted in COVID-19 treatment facilities in Zambia. Specifically, we assessed associations between HIV infection and COVID-19 severity and mortality. Methods: We collected demographic and clinical information from all adult patients admitted with SARS-CoV2 infection across five inpatient facilities in Zambia from July to October 2020. Logistic regression was utilized to examine the association between HIV status and COVID-19 severity, defined as the need for supplemental oxygen at any point during admission;and survival analyses were employed to explore the relationship between HIV status and 28-day mortality. Regression analyses were adjusted for age, sex, and facility. Results: There were 182 cases of severe COVID-19 among 271 enrolled patients. Overall, 66 (24%) patients were HIV-infected, 146 (54%) were male, and 53 (20%) were >60 years. Most HIV-infected patients (87%) were on antiretroviral therapy (ART) and among those with viral load results, 86% were virally suppressed (<1000 cp/ml). Compared to HIV-uninfected patients, those who were HIV-infected had lower BMI (mean: 26.0 vs. 28.0, p=0.05), and were less likely to be hypertensive (34.8% vs. 47.4%, p=0.01). HIV infection was not a significant predictor of severe disease (adjusted odds ratio: 1.71, 95% CI: 0.88 - 3.46), nor was it associated with 28-day mortality (adjusted hazard ratio: 0.87, 95% CI: 0.39 - 1.94). Conclusion: In this study from a sub-Saharan African (SSA) country with a generalized HIV epidemic, HIV had no statistically significant impact on COVID-19 severity or mortality. Most of the HIV-infected population in this study were virally suppressed and this may indicate that with optimal ART and achievement of HIV viral suppression, the risk of severe disease or mortality from COVID-19 among people living with HIV (PLHIV) can be minimized. Additional studies that assess impact of COVID-19 on PLHIV not on ART are needed, as this group continues to make up a large portion of PLHIV in SSA.