Epidemiology and outcomes of COVID-19 in HIV-infected individuals: a systematic review and meta-analysis

Abstract

Susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the risk of mortality among people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA) is largely unknown. PLWHA are unique due to their altered immune system from their history of chronic HIV infection and their use of antiretroviral therapy, some of which have been used experimentally to treat coronavirus disease 2019 (COVID-19). Therefore, we conducted a systematic review and meta-analysis to assess the epidemiology of SARS-COV-2/HIV coinfection and estimate associated mortality from COVID-19 (Prospero Registration ID: CRD42020187980). PubMed, SCOPUS, OVID and Cochrane Library databases, and medRxiv preprint repositories were searched from January 1, 2020, to December 12, 2020. Data were extracted from studies reporting COVID-19 attack and mortality rates in PLWHA compared to their HIV-negative counterparts. Pooled attack and mortality risks were quantified using random-effects models. We identified 22 studies that included 20,982,498 participants across North America, Africa, Europe, and Asia. The median age was 56 years, and 50% were male. HIV-positive persons had a significantly higher risk of SARS-CoV-2 infection [risk ratio (RR) 1.24, 95% CI 1.05-1.46)] and mortality from COVID-19 (RR 1.78, 95% CI 1.21-2.60) than HIV-negative individuals. The beneficial effects of tenofovir and protease-inhibitors in reducing the risk of SARS-CoV-2 infection and death from COVID-19 in PLWHA remain inconclusive. HIV remains a significant risk factor for acquiring SARS-CoV-2 infection and is associated with a higher risk of mortality from COVID-19. In support of the current Centers for Disease Control and Prevention (CDC) guidelines, persons with HIV need priority consideration for the SARS-CoV-2 vaccine.

Figure 1

PRISMA flowchart of a systematic review and meta-analysis of HIV and SARS-CoV-2 coinfection.

Figure 2

Association of HIV and attack rate of SARS-CoV-2. Blue squares and their corresponding lines are the point estimates and 95% confidence intervals from each study. Maroon diamond represents the pooled effect estimate.

Figure 3

HIV prevalence in populations COVID-19 and the general population. (A) Local Prevalence of HIV in cities where COVID-19 studies were conducted. (B) Prevalence of HIV in patients hospitalized for COVID-19. Blue squares and their corresponding lines are the point estimates and 95% confidence intervals per each study. Maroon diamond represents the pooled effect estimate.

Figure 4

Prevalence of HIV in patients hospitalized for COVID-19 stratified by country. Blue squares and their corresponding lines are the point estimates and 95% confidence intervals per each study. Maroon diamond represents the pooled effect estimate.

Figure 5

Association of HIV and mortality risk from COVID-19. Blue squares and their corresponding lines are the point estimates and 95% confidence intervals per each study. Maroon diamond represents the pooled effect estimate.

Figure 6

Mortality rates in COVID-19 individuals living with HIV/AIDS: mortality rates in HIV patients hospitalized COVID-19 stratified by country. Blue squares and their corresponding lines are the point estimates and 95% confidence intervals per each study. Maroon diamond represents the pooled effect estimate.