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Background Factors affecting outcomes of SARS-CoV-2 infection in people living with HIV are unclear. We assessed the factors associated with SARS-CoV-2 diagnosis and severe outcomes among people living with HIV. Methods We did a retrospective cohort study using data from the PISCIS cohort of people with HIV in Catalonia (Spain) between March 1 and Dec 15, 2020. We linked PISCIS data with integrated health-care, clinical, and surveillance registries through the Public Data Analysis for Health Research and Innovation Program of Catalonia (PADRIS) to obtain data on SARS-CoV-2 diagnosis, chronic comorbidities, as well as clinical and mortality outcomes. Participants were aged at least 16 years in care at 16 hospitals in Catalonia. Factors associated with SARS-CoV-2 diagnoses and severe outcomes were assessed using univariable and multivariable Cox regression models. We estimated the effect of immunosuppression on severe outcomes (hospital admission for >24 h with dyspnoea, tachypnoea, hypoxaemia, asphyxia, or hyperventilation; or death) using Kaplan-Meier survival analysis. Findings We linked 20 847 (72middot8%) of 28 666 participants in the PISCIS cohort with PADRIS data; 13 142 people had HIV. 749 (5.7%) people with HIV were diagnosed with SARS-CoV-2: their median age was 43middot5 years (IQR 37middot0-52middot7), 131 (17middot5%) were female, and 618 (82.5%) were male. 103 people with HIV (13.8%) were hospitalised, seven (0.9%) admitted to intensive care, and 13 (1.7%) died. SARS-CoV-2 diagnosis was more common among migrants (adjusted hazard ratio 1.55, 95% CI 1.31-1.83), men who have sex with men (1.42, 1.09-1.86), and those with four or more chronic comorbidities (1.46, 1.09-1.97). Age at least 75 years (5.2, 1.8-15.3), non-Spanish origin (2.1, 1.3-3.4), and neuropsychiatric (1.69, 1.07-2.69), autoimmune disease (1.92, 1.14-3.23), respiratory disease (1.84, 1.09-3.09), and metabolic disease (2.59, 1.59-4.23) chronic comorbidities were associated with increased risk of severe outcomes. A Kaplan-Meier estimator showed differences in the risk of severe outcomes according to CD4 cell count in patients with detectable HIV RNA (p=0.039) but no differences were observed in patients with undetectable HIV RNA (p=0.15). Interpretation People living with HIV with detectable HIV viraemia, chronic comorbidities, and some subpopulations could be at increased risk of severe outcomes from COVID-19. These groups should be prioritised in clinical management and SARS-CoV-2 vaccination programmes.