African Journal of Thoracic and Critical Care Medicine · Oct 21, 2026

The effects of HIV and multimorbidity on the clinical outcomes of hospitalised adults with COVID‐19

By Pillay S, Singh U, Pillay S et al.

Background. South Africa (SA) presents a unique epidemiological context characterised by a high prevalence of both HIV infection and rising non-communicable diseases (NCDs), which may interact to adversely affect COVID-19 outcomes. Objectives. To investigate the determinants of in-hospital mortality among patients with COVID-19, with particular emphasis on HIV status and coexisting comorbid conditions. Methods. A retrospective cohort study was conducted among adult patients with COVID-19 admitted to a tertiary hospital in KwaZulu-Natal Province, SA, between January 2021 and April 2022. Demographic and clinical data were extracted from patients’ medical records. Independent predictors of in-hospital mortality were identified using a multivariable Cox proportional hazards regression model. Results. Among the 753 patients included in the cohort, 22.9% were HIV positive, of whom 58.2% had an unsuppressed HIV viral load. In addition, 48.3% of participants presented with one or more comorbid conditions: 21.4% had a single comorbidity, 16.7% had two, and 10.2% had three or more. Most of the cohort (90.6%) were not vaccinated against COVID-19. The overall in-hospital COVID-19 case fatality rate was 21.0%. Mortality was significantly higher among patients who required advanced respiratory support (adjusted hazard ratio (aHR) 5.51, 95% confidence interval (CI) 3.40 - 8.96, p=0.001) and those who developed acute kidney injury (AKI) (aHR 1.62, 95% CI 1.09 - 2.42, p=0.017) than among those who did not. Age <45 years was independently associated with a reduced risk of death (aHR 0.55, 95% CI 0.34 - 0.88, p=0.013). The presence of any comorbidity significantly increased the risk of mortality (aHR 1.60, 95% CI 1.12 - 2.30, p=0.011). Neither HIV status nor HIV virological control was independently associated with mortality (p=0.819). Conclusion. In this SA cohort, advancing age, the need for supplemental oxygen or more advanced respiratory support, AKI and comorbidities burden emerged as key determinants of COVID-19-related mortality. These findings underscore the importance of addressing NCDs as part of an integrated care strategy for reducing COVID-19-related mortality in high-risk populations.

doi.org/10.7196/ajtccm.2026.v32i3.4674Open accessPopulations