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COVID-19 symptoms and SARS-CoV-2 infection among people living with HIV in the US: the MACS/WIHS combined cohort study

Our take —

This study, conducted in long-standing cohorts of HIV-negative and HIV-positive individuals, suggests that there is little difference between those with and without HIV in terms of their symptoms when testing positive for SARS-CoV-2. There was some evidence that people living with HIV may be at increased risk for infection, but some potential confoundin factors remain unaddressed.

Study design


Study population and setting

The study was conducted in the Multicenter AIDS Cohort Study (MACS) and Women’s Interagency HIV Study (WIHS), two cohorts which include HIV positive patients in the United States. The authors conducted a telephone survey among participants in the MACS and WIHS cohorts from April to June 30, 2020 to identify participants who had been infected by SARS-CoV-2 by asking about 14 individual COVID-19 symptoms, their duration and severity, and SARS-CoV-2 testing and results (with medical record verification when possible). They used data from the existing cohort to identify factors associated with diagnosed SARS-CoV-2 infection, including having HIV.

Summary of Main Findings

The authors were able to survey 83% of the cohort participants they contacted (3411/ 4123). Of those, 2078 had HIV and 1333 did not. Among participants surveyed, only 13% (441/4123) had been tested for SARS-CoV-2 with similar proportions among those HIV positive and HIV negative. Nearly all participants reported practicing social distancing (98%) and staying home (97%) and these were similar among those with and without HIV. Those with HIV were more likely to test positive for SARS-CoV-2 (11.2%) than those who were HIV negative (6.1%), but not significantly so. Of all subjects, 53% reported at least one symptom. Reported symptoms were also similar between the two groups in terms of type and severity. Overall, 441 (12.9%) reported testing for SARS-CoV-2, with no differences between those with and without HIV. Among those who were tested, for the odds of testing positive for SARS-CoV-2 were higher among those who were HIV positive compared to negative (adjusted odds ratio (aOR) 2.22 95%CI: 1.01, 4.85) and those living with others versus living alone (aOR 2.95 95%CI 1.18, 7.40).

Study Strengths

The study was conducted in two well documented and described cohorts and as such, the underlying population is easy to identify. They were able to compare those who were HIV positive to those who are HIV negative with confidence due to the underlying cohort design, something few other cohorts are able to do. SARS-CoV-2 diagnoses were confirmed with medical records, where possible.


Fourteen percent of cohort members were unable to be reached for the survey, and it’s possible that some participants may have been unreachable due to severe illness. In addition, participants likely had some control over whether or not they were ever tested for SARS-CoV-2, and it’s possible that some infections may have been missed. There is also likely some uncontrolled confounding even after adjustment.

Value added

There is currently little information about the risk for SARS-CoV-2 infection and severe disease among those living with HIV. This study offers unique insights from existing, well-documented cohorts to show that severity of COVID-19 appears similar between those with and without HIV.

This review was posted on: 3 January 2021