Low CD4 Count with HIV = Higher Risk for COVID-19

A low CD4 count in people living with HIV is often associated with immune deficiency. The question addressed by this study is whether this indicator of decreased immune function in persons living with HIV is related to an increased risk of COVID-19.  Data from 3 countries were used to identify risk factors for morbidity and mortality from COVID-19.  Besides CD4 count, risk factors such as gender, age, and presence of at least one comorbidity were studied.   

Among data from 175 patients, 49 (28%) had severe COVID-19 and 7 (4%) patients died. Almost all of the participants were receiving antiretroviral therapy and 94% had low HIV RNA counts before getting the virus. In the first analysis done, an age of 50 years old or older, a history of a CD4 count of less than 200 (i.e., a level suggesting AIDS), current CD4 count less than 350, or the presence of at least one comorbidity were significantly related to the severity of COVID-19. However, no relationship was found regarding gender, ethnicity, obesity, a detectable HIV RNA, or various drugs used in the treatment of HIV. Using all the factors in an analysis, the only factor significantly related to the risk of severe COVID-19 was a CD4 count of less than 350. Death was related to a history of a low CD4 count.

Using this available measure of immune deficiency, it appears that a low CD4 count increases risk for COVID-19 in people living with HIV.  This observation suggests that there is a need to use all available strategies to increase CD4 levels starting with early diagnosis and treatment plus maintaining adherence to HIV medication. In addition to optimal treatment of existing comorbidities, the most important strategy is to have complete vaccination against COVID -19 as indicated by your health care team. In addition, because immune deficiency may occur more frequently in people living with HIV- especially older persons- it may be determined that a third booster shot is recommended for those who already have received 2 vaccine injections,  


Source: Hoffmann, C., et al. (2021). “Immune deficiency is a risk factor for severe COVID-19 in people living with HIV.” HIV Med 22(5): 372-378.