Risk of adverse coronavirus disease 2019 outcomes for people living with HIV

Abstract

Objective: To assess whether people living with HIV (PLWH) are at increased risk of coronavirus disease 2019 (COVID-19) mortality or adverse outcomes, and whether antiretroviral therapy (ART) influences this risk. Design: Rapid review with meta-analysis and narrative synthesis. Methods: We searched databases including Embase, Medline, medRxiv and Google Scholar up to 26 August 2020 for studies describing COVID-19 outcomes in PLWH and conducted a meta-analysis of higher quality studies. Results: We identified 1908 studies and included 19 in the review. In a meta-analysis of five studies, PLWH had a higher risk of COVID-19 mortality [hazard ratio 1.95, 95% confidence interval (CI): 1.62–2.34] compared with people without HIV. Risk of death remained elevated for PLWH in a subgroup analysis of hospitalized cohorts (hazard ratio 1.60, 95% CI: 1.12–2.27) and studies of PLWH across all settings (hazard ratio 2.08, 95% CI: 1.69–2.56). Eight other studies assessed the association between HIV and COVID-19 outcomes, but provided inconclusive, lower quality evidence due to potential confounding and selection bias. There were insufficient data on the effect of CD4 + T-cell count and HIV viral load on COVID-19 outcomes. Eleven studies reported COVID-19 outcomes by ART-regimen. In the two largest studies, tenofovir disoproxil fumarate-based regimens were associated with a lower risk of adverse COVID-19 outcomes, although these analyses are susceptible to confounding by co-morbidities. Conclusion: Emerging evidence suggests a moderately increased risk of COVID-19 mortality among PLWH. Further investigation into the relationship between COVID-19 outcomes and CD4 + T-cell count, HIV viral load, ART and the use of tenofovir disoproxil fumarate is warranted.

Tenofovir, Another Inexpensive, Well-Known and Widely Available Old Drug Repurposed for SARS-COV-2 Infection

“…Clinical studies conducted thus far seem to suggest that TDF, but not TAF, based-ART may reduce COVID-19 incidence, risk of hospitalization and mortality in HIV-infected patients [ 19 , 94 , 95 , 96 ], while a preventive effect of TDF or TAF on COVID-19 is suggested by studies on HIV-negative PrEP users [ 99 ]. Taken together, although the available observational studies are few and do not provide conclusive data on TDF or TAF protective effects, the first compelling evidence suggests that more studies are needed to understand the role of this drug, both in COVID-19 treatment and prevention.…”

“…A recent meta-analysis [ 19 ] focused on the risk of several adverse COVID-19 outcomes in HIV-infected patients. The authors identified 11 studies that assessed the impact of ART on COVID-19 outcome in HIV-infected patients with no conclusive results (HIV-infected patients on ART with COVID-19, n = 4726, comprising the studies described above in [ 94 , 95 , 96 ]).…”

“…Up until now, it is not clear whether HIV infection increases COVID-19 risk in settings with complete access to antiretroviral drugs (ARVs) against HIV [ 19 , 20 , 21 , 22 , 23 ]. The concern over increased risk for severe COVID-19 disease for HIV-infected patients may be based on the assumption that these subjects are more likely to be immunosuppressed because HIV infection is associated with abnormal humoral and T-cell–mediated immune responses, resulting in increased susceptibility to numerous opportunistic infections.…”

“…It is not known if people living with HIV (PLWH), who are clinically and virologically stable, experience any greater risk for COVID-19 complications than the population without HIV infection [ 19 , 20 , 21 , 22 , 23 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ], and there is a possible protective role of antiretroviral therapy (ART) [ 43 , 44 ]. At present, the available data mainly appear in case reports and case series of SARS-CoV2/HIV co-infected patients [ 44 , 45 , 46 , 47 ].…”

SARS-CoV-2 Portrayed Against HIV: Contrary Viral Strategies in Similar Disguise

“…In summary, accumulating data direct towards a slightly increased risk of severe COVID-19 outcomes with underlying HIV-1 infection, particularly in patients that are sub-optimally treated and immunocompromised [535]. Studies with higher case numbers with full adjustment of confounders need to confirm these preliminary findings.…”