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Review
. 2021 Apr 15;22(1):1220.
doi: 10.4102/sajhivmed.v22i1.1220. eCollection 2021.

Human immunodeficiency virus and mortality from coronavirus disease 2019: A systematic review and meta-analysis

Timotius I Hariyanto  1 , Jane Rosalind  1 , Kevin Christian  1 , Andree Kurniawan  2
Affiliations
Review

Human immunodeficiency virus and mortality from coronavirus disease 2019: A systematic review and meta-analysis

Timotius I Hariyanto et al. South Afr J HIV Med. .

Abstract

Background: Persons living with human immunodeficiency virus (PLWH) constitute a vulnerable population in view of their impaired immune status. At this time, the full interaction between HIV and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been incompletely described.

Objective: The purpose of this study was to explore the impact of HIV and SARS-CoV-2 co-infection on mortality.

Method: We systematically searched PubMed and the Europe PMC databases up to 19 January 2021, using specific keywords related to our aims. All published articles on coronavirus disease 2019 (COVID-19) and HIV were retrieved. The quality of the studies was evaluated using the Newcastle-Ottawa Scale for observational studies. Statistical analysis was performed with Review Manager version 5.4 and Comprehensive Meta-Analysis version 3 software.

Results: A total of 28 studies including 18 255 040 COVID-19 patients were assessed in this meta-analysis. Overall, HIV was associated with a higher mortality from COVID-19 on random-effects modelling {odds ratio [OR] = 1.19 [95% confidence interval (CI) = 1.01-1.39], p = 0.03; I 2 = 72%}. Meta-regression confirmed that this association was not influenced by age (p = 0.208), CD4 cell count (p = 0.353) or the presence of antiretroviral therapy (ART) (p = 0.647). Further subgroup analysis indicated that the association was only statistically significant in studies from Africa (OR = 1.13, p = 0.004) and the United States (OR = 1.30, p = 0.006).

Conclusion: Whilst all persons ought to receive a SARS-CoV-2 vaccine, PLWH should be prioritised to minimise the risk of death because of COVID-19. The presence of HIV should be regarded as an important risk factor for future risk stratification of COVID-19.

Keywords: AIDS; COVID-19; HIV; SARS-CoV-2; coronavirus disease 2019.

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Conflict of interest statement

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

Figures

FIGURE1
FIGURE1
PRISMA diagram of the detailed process of selection of studies for inclusion in the systematic review and meta-analysis.
FIGURE 2
FIGURE 2
Forest plot that demonstrates the association of HIV with mortality from COVID-19 outcome.
FIGURE 3
FIGURE 3
Bubble-plot for meta-regression. Meta-regression analysis showed that the association between HIV and mortality from COVID-19 was not affected by gender (a), CD4 cell count (b) or ART (c).
FIGURE 4
FIGURE 4
Funnel plot for the association of HIV with mortality from COVID-19 outcomes.
See this image and copyright information in PMC

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