Outcomes of patients with HIV and COVID-19 co-infection: a systematic review and meta-analysis

Abstract

Background Data on the association of human immunodeficiency virus (HIV) infection with adverse outcomes in patients with COVID-19 are conflicting. This systematic review and meta-analysis aimed to summarize the available information on the risk of hospitalization, severe disease, and death attributable to HIV in patients with COVID-19. Methods PubMed, EMBASE, Web of Science, and SCOPUS were searched through October 25, 2021, to identify relevant studies, without language restriction. A random-effects model was used to pool estimates. Results We included 44 studies reporting information from 38,971,065 patients with COVID-19. The pooled prevalence of HIV among COVID-19 patients was 26.9 ‰ (95% CI 22.7–31.3) and was significantly higher in studies conducted in Africa compared to those conducted elsewhere (118.5‰ [95% CI 84.8–156.9, 11 studies] vs 10.9‰ [95% CI 8.8–13.2, 27 studies]). In pooled analyses of unadjusted odds ratio, HIV-positive individuals were more likely to be admitted to hospital (OR: 1.49; 95% CI 1.01–2.21, 6 studies) compared to HIV-negative individuals. In the adjusted (for age and sex) analyses, HIV was associated with an increased risk of death (hazard ratio: 1.76, 95% CI 1.31–2.35, 2 studies). However, HIV was not associated with the severity of the disease (OR: 1.28; 95% CI 0.77–2.13, 13 studies), or death (OR: 0.81; 95% CI 0.47; 1.41, 23 studies) in patients with COVID-19 in the meta-analysis of unadjusted odds ratio. Conclusion Our findings suggest that patients with HIV have an increased risk of hospital admission for COVID-19. HIV seems to be independently associated with increased risk of mortality in COVID-19 patient in adjusted analysis. However, this evidence was derived from only two studies.

The impact of COVID-19 on communicable and non-communicable diseases in Africa: a narrative review

“…Current data on the association between HIV infection and adverse outcomes in COVID-19 have not been conclusive. A recent meta-analysis pointed to a potential greater risk of hospital admission for COVID-19 in people living with HIV (PLWH), with no clear evidence of increased risk of death or developing severe COVID-19 [9]. On the other hand, risk of COVID-19 mortality in PLWH may depend on the residence country [10].…”

“…Several gaps in the interplay between COVID-19 and HIV deserve to be addressed urgently. In contexts of scarce resources, understanding of whether HIV is associated with increased mortality becomes of huge importance for prioritization of COVID-19 care and vaccination programs and for optimal allocation of public health interventions [9,14].…”

Coinfection of leptospirosis and coronavirus disease 2019: A retrospective case series from a coastal region in South India

“… 3 Amongst infections, chronic infections such as human immunodeficiency virus infection in the context of COVID‐19 have been discussed in many reports, but tropical infections such as leptospirosis have been largely neglected. 4 , 5 Although there are some reports of leptospirosis during the COVID‐pandemic, the complex interplay between COVID and leptospirosis has not been evaluated in detail to the best of our knowledge. 6 Leptospirosis is a febrile zoonotic disease with rodents and other small mammals serving as reservoirs.…”

Household transmission of SARS-CoV-2 from adult index cases living with and without HIV in South Africa, 2020-2021: a case-ascertained, prospective observational household transmission study

“…[3] Few studies report the influence of HIV infection on SARS-CoV-2 transmission, duration of shedding and clinical severity, with most data available from high income countries and little evidence from sub-Saharan Africa where most people LWH reside. [4] Evidence from multiple studies suggests that people LWH are at greater risk for hospitalisation [5][6][7][8] and death [7][8][9][10][11] when infected with SARS-CoV-2, but that SARS-CoV-2 prevalence is similar between people LWH and HIV-uninfected individuals, [12] Risk for hospitalisation and death increases with a decline in CD4+ T cells. [6,7,11] Limited data are available on the role of HIV in the transmission of SARS-CoV-2.…”