Progression risk in people with HIV and COVID-19: Predictive performance of current risk scores.

People with HIV (PWH) might have a higher risk of adverse coronavirus disease 2019 (COVID-19) outcomes. Several scores were developed to predict COVID-19 progression to critical disease and are often used among PWH. We assessed the performance of two commonly used risk equations among PWH and COVID-19. METHODS: Participants were identified from a multicenter cohort of 6,361 PWH on regular follow-up at two university hospitals. Of 99 HIV-infected individuals with confirmed SARS-CoV-2 infection, 63 had complete data and were included in this analysis. CALL and COVID-GRAM scores were calculated and participants were stratified into low, intermediate, and high-risk for each. Discrimination was assessed using receiver operating characteristic curves. Calibration was evaluated using observed-versus-expected ratios and Hosmer-Lemeshow X2 goodness of fit statistic. Scores were adjusted by increasing one category level in individuals with nadir CD4 lymphocyte count <200/µL. RESULTS: Participants had a median nadir and current CD4 counts of 207 (interquartile range, IQR, 119-345) and 440 (IQR 280-719) cells/µL. Ten (15.9%) individuals progressed to critical disease and 4 (6.3%) died. Assessed scores showed acceptable discrimination (area under the curve, 0.701-0.771) and were overall calibrated (observed-versus-expected ratio, O:E, 1.01). However, both overestimated the risk of progression among individuals in the low and high-risk categories, and underestimated the risk in the intermediate category (O:E 1.20-1.21). Thus, 50% of critically ill individuals were not identified as high-risk. Assigning PWH with low nadir CD4 count a higher risk of progression reduced the proportion of individuals not identified to 20%. CONCLUSIONS: COVID-19 risk scores had lower performance in PWH compared to that described in the general population and failed to adequately identify individuals who progressed to critical disease. Adjustment for nadir CD4 partially improved their accuracy. Risk equations incorporating HIV-related factors are needed.