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BRISBANE, Australia -- While Omicron was generally considered to be a milder strain of SARS-CoV-2 that led to fewer deaths, there was scant relief for people living with HIV who were hospitalized during this wave of COVID-19, researchers reported here.

Overall death rates were 19.6% for people with HIV compared with 9.8% for those without HIV among a dataset of over 126,000 patients hospitalized during Omicron, reported Nathan Ford, MPH, PhD, of the World Health Organization (WHO) in Geneva, during his oral presentation at the International AIDS Society Conference on HIV Science.

The differences in mortality rates for people with and without HIV who required hospitalization for COVID during the pre-Delta and Delta waves of infection were less pronounced, Ford noted.

• Of the 543,084 patients hospitalized during the pre-Delta wave, 24.2% of those who had HIV died compared with 22% who did not have HIV
• Of the 151,720 patients hospitalized during the Delta wave, 23.4% versus 20.9% died, respectively

"The main finding is that while mortality risk among HIV-negative individuals decreased dramatically comparing the pre-Delta and Delta period with Omicron, there was only a modest reduction observed among people living with HIV, and especially those with low CD4 counts," Ford said.

Among people living with HIV who had a CD4 count ≤200 cells/µL, there was a 64% increased risk of death during the pre-Delta wave, a 52% greater risk during the Delta wave, and a 79% greater risk during the Omicron wave.

While the Omicron variant had the highest risk of transmissibility, there were reduced risks of both disease severity and death, he pointed out, noting that the risk of death by the variants of concern varied by population. "People living with HIV have been shown to be at an increased risk of severe COVID-19 outcomes, but there's limited data on how this varies by variant," he added.

Of note, the risk of death among people living with HIV who were vaccinated decreased by 38% during the Delta wave, and by 39% during the Omicron wave.

"Overall, these findings help highlight the need for implementing WHO guidelines for testing and treatment for HIV at every opportunity and providing a booster vaccine for populations most at risk for severe COVID-19 outcomes, including people living with HIV," said co-author Meg Doherty, MD, PhD, director of the Global HIV, Hepatitis and Sexually Transmitted Infections Programs at WHO, during a press conference.

Press conference moderator Sharon Lewin, PhD, director of the Peter Doherty Institute for Infection and Immunity at the University of Melbourne in Australia, noted that the study results "underscore the need for equitable global access not only to COVID vaccines and boosters, but also antivirals. Today, global access to lifesaving antivirals for COVID-19 remains very limited."

For this study, Ford and colleagues used the WHO Global Clinical Platform to identify 821,331 patients who were admitted to hospitals with COVID during the pre-Delta, Delta, and Omicron waves. Of these patients, 5.3% were living with HIV.

In addition to low CD4 counts, other risk factors for mortality due to COVID among people living with HIV included older age, severe COVID at hospital admission, chronic kidney disease, and diabetes.

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