Implications of COVID-19 in high burden HIV/TB countries: 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 21st century and in the future. 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. 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. 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.

Microbial co-infections in COVID-19: Associated microbiota and underlying mechanisms of pathogenesis

“…The triple burden of COVID-19, human immunodeficiency virus (HIV) and hepatitis C virus (HCV) is one of the major and persistent global health challenges of the twenty-first century. The HIV, HCV and newly emerging infectious diseases such as coronavirus epidemics are expected to overlap in high HIV and HCB or HCV burden countries [ 64 ]. How COVID-19 will manifest itself in persons co-infected with HIV/HCV is still unclear [ 64 ].…”

“…The HIV, HCV and newly emerging infectious diseases such as coronavirus epidemics are expected to overlap in high HIV and HCB or HCV burden countries [ 64 ]. How COVID-19 will manifest itself in persons co-infected with HIV/HCV is still unclear [ 64 ]. Populations infected with HIV and HCV may be at elevated risk for severe responses if they are infected with COVID-19.…”

Profile of SARS-CoV-2-specific CD4 T cell response: Relationship with disease severity and impact of HIV-1 and activeMycobacterium tuberculosisco-infection

“…Due to the systemic inflammation induced by chronic HIV infection and active TB, questions have been raised whether these two diseases in particular could distort the immune response to SARS-CoV-2, leading to increased mortality. Indeed, emerging evidence shows that TB and HIV are independently associated with an increased risk for COVID-19 mortality (Boulle et al, 2020; Geretti et al, 2020; Tamuzi et al, 2020). Thus, we defined the impact of HIV, TB and HIV/aTB co-infection on the magnitude, phenotypic and functional profile of the SARS-CoV-2 CD4 T cell response.…”

“…Moreover, profound lymphopenia and hyper-inflammation associated with COVID-19 could favor Mtb reactivation. These concerns are further underlined by several large epidemiological studies showing that, both HIV-1 and active TB independently associate with an increased risk of COVID-19-related death (Bhaskaran et al, 2021; Boulle et al, 2020; Brown et al, 2021; Chen et al, 2020a; Davies, 2020; Geretti et al, 2020; Tamuzi et al, 2020). It is thus an urgent research priority to investigate the profile of the SARS-CoV-2-specific T cells in patients co-infected with HIV-1 and/or active TB and to assess the impact of acute SARS-CoV-2 infection on the Mtb-specific memory CD4 T cell response.…”

COVID‐19 case fatality rate and tuberculosis in a metropolitan setting

“…Although a meta‐analysis of Chinese studies did not find an association between tuberculosis and COVID‐19 severity, 6 it is important to note that these results may have been affected by the clinical heterogeneity of tuberculosis cases and sample size limitations. Moreover, another systematic review recently reported an association between tuberculosis and COVID‐19, independent of HIV status, suggesting that tuberculosis patients may be more susceptible to severe COVID‐19 and death 17 . Therefore, more studies with well‐characterized tuberculosis phenotypes and COVID‐19 coinfection are needed 18 …”