People with HIV (PWH) had a significantly higher risk of developing long COVID across multiple organ systems than people without HIV (PWoH), according to a large cohort study published in the Journal of Acquired Immune Deficiency Syndrome.

Using linked electronic health records, researchers led by a team at the University of South Carolina Arnold School of Public Health identified 838,520 adults with confirmed COVID-19 from March 2020 to January 2022. Of those, 2,662 (0.3%) had HIV. Long COVID was defined as symptoms occurring 30 to 180 days after infection across 13 organ-system categories. 

Overall, 16.3% of PWH received a long-COVID diagnosis, compared with 10.6% of PWoH, for a 29% higher risk of developing any long-COVID condition.

When the researchers looked at specific COVID-related symptoms, they found that PWH had more than double the risk of nervous-system disorders (adjusted hazard ratio [aHR], 2.04), including headache, nervous-system pain, and sleep disruptions. They also had elevated risks of mental, behavioral, and neurodevelopmental symptoms (aHR, 1.78) and respiratory diseases (aHR, 1.78).

Increased risks were also observed for endocrine and metabolic diseases (aHR, 1.70), genitourinary disorders (aHR, 1.59), digestive system diseases (aHR, 1.47), and musculoskeletal conditions (aHR, 1.45). Circulatory system diagnoses did not differ significantly between groups.

Chronic inflammation may increase susceptibility

Across the 13 types of long-COVID conditions the researchers looked at, the most common problems in both PWH and PWoH were general symptoms like fatigue and abdominal pain, as well as muscle and joint issues.

The authors note that chronic immune activation and inflammation associated with HIV, even among people receiving antiretroviral therapy, may increase susceptibility to long COVID. 

Study limitations include reliance on diagnostic codes in electronic health records, which may not have captured complete information, a lack of inflammatory marker data, and a study cohort that was predominantly Black and urban, which may limit generalizability.

Still, the authors say the findings underscore the complex, multi-organ nature of long COVID and the increased risk faced by PWH, concluding that “cross-sector collaboration among healthcare providers, community organizations, and policymakers is needed to optimize resource allocation and ensure that individuals receive the necessary treatment and maintenance.”