Risk of adverse COVID-19 outcomes for people living with HIV: a rapid review and meta-analysis

Abstract

Objective: To assess whether people living with HIV (PLWH) are at increased risk of 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 26th August 2020 for studies describing COVID-19 outcomes in PLWH and conducted a meta-analysis of higher quality studies. Results: We identified 1,908 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 (HR) 1.93, 95% Confidence Interval (CI): 1.59-2.34) compared to people without HIV. Risk of death remained elevated for PLWH in a subgroup analysis of hospitalised cohorts (HR 1.54, 95% CI: 1.05-2.24) and studies of PLWH across all settings (HR 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 (TDF)-based regimens were associated with a lower risk of adverse COVID-19 outcomes, although these analyses are susceptible to confounding by comorbidities. Conclusion: Evidence is emerging that suggests a moderately increased risk of COVID-19 mortality amongst PLWH. Further investigation into the relationship between COVID-19 outcomes and CD4+ T cell count, HIV viral load, ART and the use of TDF is warranted.

Exploring the Social Impacts of the COVID-19 Pandemic on People Living with HIV (PLHIV): A Scoping Review

“…With the US experiencing the highest number of cases of COVID-19 anywhere in the world during this time [1,63], it is not surprising the majority of publications originated there. Importantly, the biomedical and clinical impacts of COVID-19 were a key focus of the early literature, providing essential information to PLHIV about their susceptibility to COVID-19 complications [7][8][9][10][11].…”

“…Evidence investigating whether people living with HIV (PLHIV) are at heightened risk of COVID-19 complications and mortality remains mixed, particularly for those with co-morbid conditions e.g., [3][4][5][6][7][8][9]. Some suggest effective antiretroviral treatment (ART) may prevent poorer COVID-19 outcomes [10], but again the evidence base is inconclusive [7,11].…”

Follow-Up Survey of the Impact of COVID-19 on People Living with HIV during the Second Semester of the Pandemic

“…Most of the previously available data did not provide evidence that persons living with HIV (PLWH) have a higher COVID-19 infection rate or a different disease course compared to those without HIV infection [ 4 , 5 , 6 ]. However, more recent studies suggest that COVID-19 infection in PLWH is associated with increased mortality and severe clinical outcomes particularly for those with CD4 counts below 200 cells/mm³ [ 7 , 8 , 9 ].…”

HIV infection as a risk factor for COVID 19: A systematic review and meta-analysis

“…Inclusion criteria included articles that reported the risk ratio (RR) of COVID-19 infection and severity in PPV people compared to people without HIV, or if a study provided enough information to calculate the RR of admission. In the intensive care unit (ICU), mechanical ventilation and death from CO-VID-19 among PLHIV compared to HIV-negative patients with COVID-19, studies of Systematic Reviews and Metaanalyzes related to the research were also included [1][2][3][4][5][6][7][8][9][10][11][12] .…”

“…SARS-CoV-2 infection can be asymptomatic or with mild symptoms, and around 15 to 20% can develop severe coronavirus disease 2019 (COVID- 19), presenting hypoxemia, acute respiratory distress syndrome, multiple organ failure or death. The main risk factors for developing severe CO-VID-19 among the general population include advanced age, hypertension, diabetes, chronic kidney disease, chronic lung disease, and obesity 1 .…”