Publication date: May 20, 2025

SARS-CoV-2 and its subvariants continue to spread globally. People living with HIV (PLWH), who have weakened immune systems, have heightened concerns about the virus. Thus, the relationship between COVID-19 and HIV remains unclear, and the risks of COVID-19 for PLWH have yet to be fully understood. The study conducted a retrospective cross-sectional survey on the Wenjuanxing platform to identify lifestyle risk factors and epidemic phenotypes associated with the severity of COVID-19 in PLWH. All respondents were over 18 years old and were receiving antiretroviral therapy. The survey included questions about their health status during the COVID-19 illness, and questions about basic sociodemographic information, lifestyle factors, and HIV treatment history. This study included 984 HIV patients with a mean age of 54. 44 +/- 14. 4 years. Among the participants, 635 (64. 53%) were male. A total of 33 (3. 35%) respondents were unvaccinated, while 951 (96. 65%) had received at least one vaccine dose, with 868 (88. 21%) participants having received three or more vaccine doses. The association between the severity of COVID-19 symptoms and CD4 count (p = 0. 652) and HIV viral load (p = 0. 916) was found to be statistically insignificant. In reduced multivariate logistic model, passive smoking increased the risk of severe COVID-19 symptoms compared with non-smokers (odds ratios [OR] 1. 66; 95% confidence interval [CI] 1. 11-2. 48). Mild (OR 2. 23; 95% CI 1. 55-3. 24) and moderate/severe anxiety (OR 5. 22; 95% CI 2. 36-13. 28) were also positively associated with severe COVID-19 symptoms compared to individuals with no anxiety. Comorbidity (OR 1. 5; 95% CI 1. 04-2. 17) demonstrated a significant association with severe COVID-19 symptoms. Moderate/severe anxiety was significantly associated with a higher hospital admission rate (OR 2. 62; 95% CI 1. 27-5. 37) compared to those without anxiety. Patients who consumed whole grains more than three times per week had a lower risk of hospital admission (OR 0. 61; 95% CI 0. 41-0. 89). However, both anxiety and wholegrain intake were nonsignificant for hospitalization rates in individuals who tested positive for COVID-19 through real-time PCR or antigen test. In full multivariate logistic model for SARS-CoV-2 infection of hospitality, CD4 count (> 500 cells/mm) (OR 0. 64; 95% CI 0. 41-0. 99) and the CD4 count (200-500 cells/mm) (OR 0. 68; 95% CI 0. 45-1. 04) were significantly associated with hospital admission rates compared to CD4 count (

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