The risk of severe COVID-19 and mortality from COVID-19 in people living with HIV compared to individuals without HIV - a systematic review and meta-analysis of 1 268 676 individuals

Abstract

Objectives To compare mortality, hospitalization, and the need for intensive care services due to COVID-19 between PLHIV and individuals without HIV based on data from the existing literature. Methods A comprehensive search in PubMed, Cochrane Library, Scopus, China Academic Journals Full Text Database, the Database of Abstracts of Reviews of Effectiveness (DARE) and and the medRXIV and bioRxiv databases of preprints was carried out. Each data source was searched from 1 January 2020 to 20th of February 2021. Eligible studies were case control, cross-sectional and cohort studies where participants had confirmed COVID-19. From each study, data on numbers of PLHIV and individuals without HIV for each outcome were extracted. Study quality was assessed using the MethodologicAl STandard for Epidemiological Research (MASTER) scale. Data synthesis used a bias adjusted model and predefined age and geographical subgroups were analysed. Results Of a total of 2757 records identified, 11 studies, from 4 countries, the United Kingdom, Spain, the United States of America and South Africa, were included. The total participants assessed for the outcomes in this meta-analysis were 1268676 of which 13886 were PLHIV. Overall, the estimated effect of HIV on mortality suggested some worsening (OR 1.3, 95% CI: 0.9 to 2.0, I2 = 78.6%) with very weak evidence against the model hypothesis at this sample size. However, in individuals aged less than 60 years, the estimated effect on mortality suggested more worsening in PLHIV (OR 2.7, 95% CI: 1.1 to 6.5, I2 = 95.7%) with strong evidence against the model hypothesis at this sample size. HIV was also associated with an estimated effect on hospitalization for COVID-19 that suggested worsening (OR 1.6, 95% CI: 1.3 to 2.1, I2 = 96.0%) also with strong evidence against the model hypothesis at this sample size. A secondary analysis of the included studies suggested no difference, by HIV status, in the prevalence of pre-existing conditions. Conclusion People living with HIV have higher risk of death and hospitalisation from COVID-19, compared to individuals without HIV. A secondary analysis suggests this is not due to associated comorbid conditions. The difference in mortality is exaggerated in those younger than 60 years of age.