Epidemiology and outcomes of COVID-19 in HIV-infected individuals: a systematic review and meta-analysis

Abstract

Susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the risk of mortality among people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA) is largely unknown. PLWHA are unique due to their altered immune system from their history of chronic HIV infection and their use of antiretroviral therapy, some of which have been used experimentally to treat coronavirus disease 2019 (COVID-19). Therefore, we conducted a systematic review and meta-analysis to assess the epidemiology of SARS-COV-2/HIV coinfection and estimate associated mortality from COVID-19 (Prospero Registration ID: CRD42020187980). PubMed, SCOPUS, OVID and Cochrane Library databases, and medRxiv preprint repositories were searched from January 1, 2020, to December 12, 2020. Data were extracted from studies reporting COVID-19 attack and mortality rates in PLWHA compared to their HIV-negative counterparts. Pooled attack and mortality risks were quantified using random-effects models. We identified 22 studies that included 20,982,498 participants across North America, Africa, Europe, and Asia. The median age was 56 years, and 50% were male. HIV-positive persons had a significantly higher risk of SARS-CoV-2 infection [risk ratio (RR) 1.24, 95% CI 1.05–1.46)] and mortality from COVID-19 (RR 1.78, 95% CI 1.21–2.60) than HIV-negative individuals. The beneficial effects of tenofovir and protease-inhibitors in reducing the risk of SARS-CoV-2 infection and death from COVID-19 in PLWHA remain inconclusive. HIV remains a significant risk factor for acquiring SARS-CoV-2 infection and is associated with a higher risk of mortality from COVID-19. In support of the current Centers for Disease Control and Prevention (CDC) guidelines, persons with HIV need priority consideration for the SARS-CoV-2 vaccine.

COVID-19 Burden on HIV Patients Attending Antiretroviral Therapy in Addis Ababa, Ethiopia: A Multicenter Cross-Sectional Study

“…Research ndings on these concerns have been in agreement with previous studies conducted elsewhere [18,19,[33][34][35][36]. Studies indicated that though the pandemic affected the health care for all disease conditions, chronic patients such as people living with HIV are likely to be uniquely vulnerable [4,37,38]. In our ndings, those who had formal education are more likely to have care and treatment services.…”

The risk of severe COVID-19 and mortality from COVID-19 in people living with HIV compared to individuals without HIV - a systematic review and meta-analysis of 1 268 676 individuals

“…Most of the 21 studies were excluded because they had no non-HIV comparison group (n= 16), three were excluded because they did not report on the outcomes of this review (31)(32)(33), and one study was a duplicate (34). One study (19) used population-based totals and did not report totals with confirmed COVID-19 infection and was therefore excluded. A total of 11 studies were finally included.…”

Post-mortem examination of Hospital Inpatient COVID-19 Deaths in Lusaka, Zambia - A Descriptive Whole-body Autopsy Series

“…It could also due to HIV being more prevalent in people less than 55 years ( Himwaze et al, 2020 ). HIV may also play a role since it is considered a risk factor for acquiring SARS-CoV-2 infection and is associated with a higher risk of mortality from COVID-19 ( Ssentongo et al, 2021 ).…”