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Review
. 2021 Mar 15;35(4):F1-F10.
doi: 10.1097/QAD.0000000000002836.

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

Maya M Mellor  1 , Anne C Bast  1 , Nicholas R Jones  2 , Nia W Roberts  3 , José M Ordóñez-Mena  2   4 , Alastair J M Reith  1 , Christopher C Butler  2 , Philippa C Matthews  5   6 , Jienchi Dorward  2   7
Affiliations
Review

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

Maya M Mellor et al. AIDS. .

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.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram to show studies identified and included in a systematic meta-analysis of outcomes of coronavirus disease 2019 in people living with HIV.
Fig. 2
Fig. 2
Meta-analysis of the effect of HIV on risk of coronavirus disease 2019 death.
See this image and copyright information in PMC

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