Whether people living with HIV (PLWH) are at greater risk of acquiring SARS-CoV-2 infection is currently unknown. Prospective serologic studies may allow seroincidence analyses, where all infections are accurately identified. Because of this, we evaluated the incidence of associated factors with and the clinical outcome of SARS-CoV-2 infection in PLWH in Southern Spain. This prospective cohort study included PLWH from a Tertiary University Hospital in Southern Spain. Patients were enrolled in the study if (1) they had attended as outpatients our Unit from 1 August 2019 to 8 February 2020 and (2) had two subsequent evaluations from 9 February 2020 to 4 March 2021. SARS-CoV-2 infections were diagnosed by PCR, antigen detection or serology.Seven hundred and nine PLWH were included in the study. Of them, 55 [7.8%, 95% confidence interval (95% CI) 5.9%-9.9%] patients developed SARS-CoV-2 infection.Between 18 May and 29 November 2020, the rate of seroconversion was 5.3% (95% CI: 3.1%-9.0%) for the general population in the area of Seville and 2.3% (95% CI: 1.3%-2.6%) for PLWH in this study (p = .001). After multivariable analysis, adjusted by age, sex, and risk factors for HIV infection, active tobacco use and CDC stage, active tobacco smoking was the only factor independently associated with lower risk of SARS-Cov-2 infection [Incidence rate ratio: 0.29 (95% CI 0.16-0.55) p < .001].In conclusion, the incidence of SARS-CoV-2 infection among PLWH in Southern Spain during the ongoing pandemic was lower than that reported for the general population in the same area.

Objective and Design: The incidence of SARS-CoV-2 infection among people living with HIV (PLWH) has been estimated on the basis of reported symptomatic clinical cases. However, as asymptomatic cases are common and there have been limitations of health care systems for COVID-19 microbiological diagnosis, these estimations may be misleading. The availability of reliable serology for the diagnosis of COVID-19 may overcome this drawback. This study was carried out in order to reveal the actual incidence of SARS-CoV-2 infection in PLWH in Southern Spain.Methods: This is a prospective cohort study including HIV infected patients from the Unit of Infectious Diseases of a university hospital in Seville, Southern Spain. Patients were enrolled in the study if 1) they had attended the outpatient clinic from September 1st to December 31st, 2019 (baseline), and 2) had a subsequent evaluation from March 1st to June 30th, 2020 (intra-pandemic). Serum antibodies against SARS-CoV-2 were determined in baseline and intra-pandemic samples.Results: 326 patients were included in the study. Of them, 4 (1.25% [95% CI: 0.3%-3.1%]) developed COVID-19. One patient developed bilateral pneumonia and died. The remaining three showed mild respiratory symptoms suggesting COVID-19. No asymptomatic SARS-CoV-2 infection was observed in this study. No patient with COVID-19 was tobacco smoker. The incidence of COVID-19 among non-smokers was 2.5% (95% CI [0.6%-6%], p=0.057 versus smokers).Conclusions: The incidence of COVID-19 among PLWH in our area was low and similar to that observed in the general population. The frequency of asymptomatic cases might be lower than in patients without HIV infection. Tobacco smoking could be associated to a lower incidence of COVID-19.

Importance: Information about risk factors for SARS-CoV-2 infection and COVID-19 outcome among people living with human immunodeficiency virus (PLWH) is limited. Furthermore, the impact of smoking on the risk of developing COVID-19 is unclear and has been a matter of controversy.Objective: To evaluate the relationship between current tobacco smoking and the probability of SARS-CoV-2 infection acquisition among PLWH.Design: Retrospective nested case-control study performed within a cohort of 702 PLWH.Settings: University Hospital in Spain (February-October 2020).Participants: Cases were the 18 patients from this cohort with a confirmed diagnosis of COVID-19. Control group included the remaining 684 PLWH without a diagnosis of COVID-19.Exposure: Active tobacco smoking vs. non-smoking, using self-reported electronic health record data.Outcome and Measure: Development of COVID-19. Diagnosis of COVID-19 was established by the detection of SARS-CoV-2 RNA or antigen by PCR or EIA, respectively, or by the presence of plasma SARS-CoV-2 antibodies by ECLIA.Results: In 11 (61.1%) of the 18 patients, COVID-19 diagnosis was based on PCR, 4 (22.2%) on antigen and 3 (16.7%) on serology determinations. In the control group, 380 (54.1%) individuals were also tested. Regarding clinical spectrum, 2 (11.1%) patients were asymptomatic, 12 (66.6%) had upper-respiratory tract infections and 2 (11.1%) had viral pneumonia and one (5.6%) individual showed extra respiratory symptoms. One (5.6%) patient developed severe pneumonia and died. Three hundred and sixty-nine (52.6%) individuals were active smokers, 2 (11.1%) at the COVID-19 diagnosis and 367 (54.1%) in control group (p=0.001). In the bivariate analysis, only tobacco smoking was associated with a greater risk of COVID-19 [unadjusted OR=9.41 95% Confidence Interval (95% CI, 2.15-41.24); p=0.003]. Multivariate analysis, adjusted by sex, tobacco smoking and Charlson index, showed that tobacco smoking was independently related to a higher probability of SARS-CoV2 infection [aOR=9.42 (95% CI 2.15-41.33), p = 0.003].Conclusion and Relevance: Active tobacco smoking is associated with a lower incidence of SARS-CoV-2 infection in PLWH. The underlying mechanisms by which tobacco smoking may protect against SARS-CoV-2 infection should be further investigated. In the meanwhile, public-facing messages about a protective effect of tobacco smoking on the risk of COVID-19 must be avoided.

Background: Whether people living with HIV (PLWH) are at greater risk of acquiring SARS-CoV-2 infection is currently unknown. Prospective serologic studies may allow seroincidence analyses, where all infections are accurately identified. Because of this, we evaluated the incidence of and associated factors with SARS-CoV-2 infection in PLWH in Southern Spain. Methods: This was a prospective cohort study including PLWH from a University Hospital in Southern Spain. Patients were enrolled if 1) they had attended as outpatients our Unit from August 1st, 2019 to February 8th, 2020; 2) had two subsequent evaluations from February 9th, 2020 to February 15th, 2021. Serum antibodies against SARS-CoV-2 were determined in baseline and intra-pandemic samples. Results: 710 PLWH were included in the study. Of them, 46 [6.5%, 95% confidence interval (95% CI): 4.8%-8.5%] patients developed SARS-CoV-2 infection. Between May 18th and November 29th, 2020, the rate of seroconversion was 5.3% (95% CI: 3.1%-9%) for the general population in the area of Seville and 2.3% (95% CI: 1.3%-3.6%) for PLWH in this study (p=0.001). After multivariate analysis, adjusted by age and sex, active tobacco smoking was the only factor independently associated with lower risk of SARS-Cov-2 infection (Incidence rate ratio 0.35, 95% CI: 0.18-0.68, p=0.002). Conclusions: The incidence of SARS-CoV-2 infection among PLWH in Southern Spain during the ongoing pandemic was lower than that reported for the general population in the same area. Tobacco smoking was the only factor independently associated with a lower risk of incident SARS-CoV-2 infection.

SummaryThe relationship between tobacco smoking and SARS-CoV-2 infection is poorly understood. We aimed to assess the impact of current smoking on the risk of COVID-19 acquisition in a well-controlled HIV-infected population. We found that, in this setting, tobacco smoking is associated with a lower risk of acquiring SARS-CoV-2 infection.