COVID-19 in-hospital mortality in South Africa: the intersection of communicable and non-communicable chronic diseases in a high HIV prevalence setting

Abstract

Background: The interaction between COVID-19, non-communicable diseases, and chronic infectious diseases such as HIV and tuberculosis (TB) are unclear, particularly in low- and middle-income countries (LMIC) in Africa. We investigated this interaction using a nationally representative hospital surveillance system in South Africa. Methods: A national surveillance system for laboratory-confirmed COVID-19 hospital admissions (DATCOV) was established. Using DATCOV data, we describe the demographic characteristics, clinical features, and in-hospital mortality among individuals admitted to public and private hospitals with COVID-19 during 5 March to 11 August 2020. Multivariable logistic regression models were used to compare individuals who were HIV-infected and HIV-uninfected and determine the factors associated with in-hospital mortality. Findings: Hospital admissions peaked at 1,560 admissions per day, in late July. Among the 41,877 individuals admitted with laboratory-confirmed COVID-19, 7,662 (18.3%) died. Comorbidities were documented in 27,555 (65.8%) individuals, most commonly observed were hypertension (36.8%), diabetes (29.6%), obesity (19.7%), and HIV (8.7%); TB was reported in 0.7% of individuals. Increased risk of in-hospital mortality was associated with HIV and TB, as well as other described risk factors for COVID-19, such as increasing age, male sex, non-White race (Black, mixed and Indian race), chronic underlying conditions particularly hypertension, diabetes and obesity. In addition, HIV-infected individuals with immunosuppression had increased risk of mortality (adjusted odds ratio 2.2; 95% confidence interval 1.6-3.1). Among HIV-infected individuals, the prevalence of other comorbidities associated with severe COVID-19 outcomes was 39.9%. The effect of multiple comorbidities on mortality was similar in HIV-infected and -uninfected individuals. Interpretation: These data provide a better understanding of the interaction of non-communicable diseases, chronic infectious diseases like HIV and TB and COVID-19. Increasing age and presence of chronic underlying comorbidities (particularly hypertension and diabetes) are important additional factors associated with COVID-19 mortality in a middle-income African setting and are common among HIV-infected individuals. HIV- and TB-infected individuals, particularly those with additional comorbidities, would benefit from COVID-19 prevention and treatment programmes.

Clinical outcomes of hospitalised COVID-19 patients at Mthatha Regional Hospital, Eastern Cape, South Africa: A retrospective study

“…The national surveillance system for COVID-19 hospitalisations conducted by the NICD reported age and underlying medical conditions as potential risk factors for COVID-19 in-hospital mortality. 16 Similar findings were reported from a meta-analysis of clinical characteristics of covid-19 patients in Africa where clinical outcomes directly correlate with the underlying medical conditions and age. 17 Furthermore, this high mortality rate amongst the elderly with comorbidity was also reported from many international studies from France, the United Kingdom and Germany in the same age groups.…”

National COVID-19 Hospital Admissions and Mortality Among Healthcare Workers in South Africa, 2020-2021

“…In addition, as previously reported byJassat et al (2002) that HIV and TB increased the risk of hospital mortality in the general population(40), we found that HIV infection in HCWs was not associated with COVID-19 mortality in HCWs. Antiretroviral (ART) drugs such as tenofovir (TDF) and lopinavir-ritonavir have been found to reduce the risk of severe COVID-19 in people living with HIV(35,41). The lack of association in this study could be that HIV infected HCW may be receiving ART.…”

“…Pre-wave 1 [aOR 3.0; 95%CI 2.4-3.7)], wave 1 [aOR 2.1; 95%CI (1.8-2.5)] and post-wave 1 [aOR 1.3; 95%CI (1.0-1.7)] were associated with increase in HCW admissions compared to wave 2. There was an increased risk for in-hospital mortality among HCWs in the older age group (40)(41)(42)(43)(44)(45)(46)(47)(48)(49) 95%CI…”

HIV infection and risk of COVID-19 mortality

“…The 10 studies [ 19 , 21 – 29 ] included 41,113 COVID-19 patients with HIV infection and 18,081,257 COVID-19 patients without HIV infection. Among the 10 included studies, 6 studies [ 21 , 24 – 26 , 28 , 29 ] were carried out in United States, 2 studies [ 19 , 23 ] were in United Kingdom, and 2 studies [ 22 , 27 ] were in South Africa. Eight studies [ 19 , 21 , 22 , 25 – 29 ] were designed as a retrospective cohort study and 2 studies [ 23 , 24 ] were designed as a prospective cohort study.…”