People living with HIV with the Omicron variant infection have milder COVID-19 symptoms: results from a cross-sectional study, 2024, Yuting Tan et al

Abstract
Background
China braces for coronavirus disease 2019 (COVID-19) surge after adjusting the “zero COVID” strategy. We aimed to evaluate and compare the prevalence of clinical symptoms of the Omicron variant infection among people living with HIV (PLWH) and HIV-free people.

Methods
A cross-sectional study was conducted in Wuchang District, Wuhan, Hubei Province, in December 2022 by a self-administered online survey during the Omicron wave. Participants aged ≥ 18 years with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis were recruited. PLWH managed by the local healthcare system were recruited, while HIV-free people were recruited by sending out online surveys through WeChat. We compared the prevalence of clinical symptoms of COVID-19 between PLWH and HIV-free people, and factors associated with symptom occurrence among PLWH were accessed.

Results
Total, 687 PLWH and 1222 HIV-free people were enrolled. After adjusting sex, age, body mass index, comorbidities and COVID-19 vaccination status, the prevalences of all symptoms, including higher degree and long duration of fever (aOR 0.51, 95%CI 0·42 − 0·61; aOR 0.52, 95%CI 0·43 − 0·63), were significantly lower among PLWH than among HIV-free people. Among PLWH, CD4+ T lymphocyte count (CD4 count) between 350 ~ 499 cells/µL and detectable HIV viral load (HIV-VL) were associated with significantly decreased risks of fever (aOR 0·63, 95%CI 0·40 − 0·97; aOR 0·56, 95%CI 0·33 − 0·94), headache (aOR 0·61, 95%CI 0·41 − 0·91; aOR 0·55, 95%CI 0·34 − 0·92) and muscle soreness (aOR 0·57, 95%CI 0·39 − 0·84; aOR 0·57, 95%CI 0·39 − 0·84). No apparent association between the symptoms prevalence and three/four doses of inactivated COVID-19 vaccination among PLWH was observed; both males and older age were associated with significantly decreased risks of nasal congestion/runny nose (aOR 0·52, 95%CI 0·32 − 0·82; aOR 0·97, 95%CI 0·96 − 0·99) and headache (aOR 0·58, 95%CI 0·36 − 0·92; aOR 0·96, 95%CI 0·95 − 0·98); older age was associated with significantly decreased risks of higher degree of fever (aOR 0·97, 95%CI 0·95 − 0·98).

Conclusions
PLWH have significantly milder symptoms of the Omicron variant infection than HIV-free people. PLWH who are male, older, have low CD4 count, and detectable HIV-VL have reduced occurrence of COVID-19 symptoms. However, continuous monitoring should be conducted among PLWH during the COVID-19 pandemic.

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