Implications of COVID-19 in high burden countries for HIV/TB: A systematic review of evidence

Abstract

Background The triple burden of COVID-19, tuberculosis and human immunodeficiency virus is one of the major global health challenges of the 21 st century. In high burden HIV/TB countries, the spread of COVID-19 among people living with HIV is a well-founded concern. A thorough understanding of HIV/TB and COVID-19 pandemics is important as the three diseases interact. This may clarify HIV/TB/COVID-19 as a newly related field and play an important role in the present and future management of the co-infections. However, several gaps are remaining in the knowledge of the burden of COVID-19 on patients with TB and HIV, the diagnosis, and management of these patients. Objectives The study was conducted to review different studies on SARS-CoV, MERS-CoV or COVID-19 associated with HIV/TB co-infection or only TB and to understand the interactions between HIV, TB and COVID-19 and its implications on the burden of the COVID-19 among HIV/TB co-infected or TB patients, screening algorithm and clinical management. Methods We conducted electronic search of potential eligible studies published in English in the Cochrane Controlled Register of Trials, PubMed, Medrxiv, Google scholar and Clinical Trials Registry databases. We included case studies, case series and observational studies published between January, 2002 and March, 2020 in which SARS-CoV, MERS-CoV and COVID-19 co-infected to HIV/TB or TB were managed in adult patients. We screened titles, abstracts and full articles for eligibility. As we anticipated heterogeneity in the literature, results were reported narratively. Main results After removing 69 duplicates, 24 out of 246 articles were assessed for eligibility, of which 9 studies were included for qualitative analysis. Among them, we included two case reports, four case series, one case-control and two retrospective observational studies. The studies have shown that TB may occur during or after SARS-CoV. In terms of severity, the proportion of severe/critical SARS, MERS and COVID cases with TB co-infection was higher than in patients with mild/moderate stages (P= 0.0008). Conclusion SARS/MERS-CoV/COVID-19 associated to HIV/TB or TB subjects had a higher risk of developing severe/critical than mild/moderate SARS/MERS-CoV/COVID-19. Diagnostic algorithms and clinical management were suggested for efficiently improving COVID-19/HIV/TB co-infections outcomes.

The incidence and mortality of COVID-19 related TB disease in Sub-Saharan Africa: A systematic review and meta-analysis

“…This is consistent with findings in other studies including high TB post-mortem diagnostic in SSA [43, 44]. Referring to a meta-analysis showing that TB exposure was in the high-risk COVID-19 group (OR 1.67, 95% CI 1.06–2.65) [8]. COVID-19/TB clinical diagnostic may be underestimated in SSA as post-mortem TB diagnostic has shown a high mortality rate.…”

“…On the other hand, COVID-19 is associated with other co-morbidities in patients with previous or current pulmonary tuberculosis (PTB) [8]. A recent review found that PTB is a risk factor for COVID-19 regardless of HIV status, both in terms of severity and mortality [8].…”

“…On the other hand, COVID-19 is associated with other co-morbidities in patients with previous or current pulmonary tuberculosis (PTB) [8]. A recent review found that PTB is a risk factor for COVID-19 regardless of HIV status, both in terms of severity and mortality [8]. Geographically, most people who developed tuberculosis (TB) live in South-East Asia (44%), Africa (25%), and the Western Pacific (18%) [9].…”

“…However, COVID-19 associated with previous, current, or both PTB has been lower in high-burden TB countries. Both active and previous history of PTB may play a deleterious synergism SARS-CoV-2, increasing then the risk of COVID-19 associated mortality, and for patients with PTB may increase the severity of COVID-19 and of death due to chronic lung disease and immunosuppression [8]. This may contribute to higher-than-expected mortality in high PTB-burden regions such as SSA.…”

A case report of COVID-19 associated with AIDS-related pulmonary tuberculosis

“…The patients in this study had pulmonary TB, an opportunistic illness linked to AIDS that raises the probability of hospital admission for people with COVID-19 infection and lengthens stays in the critical care unit. Patients with TB lung disease or HIV-related immunosuppression may be predisposed to severe COVID-19 [7]. This study shows that HIV remains a signi cant risk factor for acquiring SARS-CoV-2 and is associated with a higher risk of COVID-19 infection-related mortality.…”