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Review
. 2022 Feb 3;7(2):22.
doi: 10.3390/tropicalmed7020022.

Global and Regional Prevalence and Outcomes of COVID-19 in People Living with HIV: A Systematic Review and Meta-Analysis

Tope Oyelade  1 , Jaber S Alqahtani  2 , Ahmed M Hjazi  3 , Amy Li  4 , Ami Kamila  5 , Reynie Purnama Raya  5   6
Affiliations
Review

Global and Regional Prevalence and Outcomes of COVID-19 in People Living with HIV: A Systematic Review and Meta-Analysis

Tope Oyelade et al. Trop Med Infect Dis. .

Abstract

Background: The relationship between HIV (human immunodeficiency virus) and COVID-19 clinical outcome is uncertain, with conflicting data and hypotheses. We aimed to assess the prevalence of people living with HIV (PLWH) among COVID-19 cases and whether HIV infection affects the risk of severe COVID-19 or related death at the global and continental level.

Methods: Electronic databases were systematically searched in July 2021. In total, 966 studies were screened following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Narratives were synthesised and data pooled for the global and continental prevalence of HIV-SARS-CoV-2 coinfection. The relative risks of severity and mortality in HIV-infected COVID-19 patients were computed using a random-effect model. Risk of bias was assessed using the Newcastle-Ottawa score and Egger's test, and presented as funnel plots.

Results: In total, 43 studies were included involving 692,032 COVID-19 cases, of whom 9097 (1.3%) were PLWH. The global prevalence of PLWH among COVID-19 cases was 2% (95% CI = 1.7-2.3%), with the highest prevalence observed in sub-Saharan Africa. The relative risk (RR) of severe COVID-19 in PLWH was significant only in Africa (RR = 1.14, 95% CI = 1.05-1.24), while the relative risk of mortality was 1.5 (95% CI = 1.45-2.03) globally. The calculated global risk showed that HIV infection may be linked with increased COVID-19 death. The between-study heterogeneity was significantly high, while the risk of publication bias was not significant.

Conclusions: Although there is a low prevalence of PLWH among COVID-19 cases, HIV infection may increase the severity of COVID-19 in Africa and increase the risk of death globally.

Keywords: COVID-19; HIV; infectious disease; pandemic; public health.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Global and regional prevalence and outcomes of COVID-19 in people living with HIV: A systematic review and meta-analysis according to the Preferred Reporting for Systematic Reviews and Meta-analyses diagram.
Figure 2
Figure 2
(a) Pooled prevalence of PLWH among COVID-19 cases. The red dotted line represents the overall effect size. The lateral edges of the blue diamonds represent the limits of the 95% confidence intervals (ES: effect size; CI: confidence interval). (b) Funnel plot of studies pooled for the prevalence of PLWH among COVID-19 cases (ES: effect size; se: standard error).
Figure 2
Figure 2
(a) Pooled prevalence of PLWH among COVID-19 cases. The red dotted line represents the overall effect size. The lateral edges of the blue diamonds represent the limits of the 95% confidence intervals (ES: effect size; CI: confidence interval). (b) Funnel plot of studies pooled for the prevalence of PLWH among COVID-19 cases (ES: effect size; se: standard error).
Figure 3
Figure 3
(a) Forest plot of studies pooled for the risk of severe COVID-19 in PLWH. The red dotted line represents the overall effect size/risk ratio. The lateral edges of the blue diamonds represent the limits of the 95% confidence intervals (RR: risk ratio; CI: confidence interval). (b) Funnel plot of studies pooled for the risk of severe COVID-19 in PLWH (CI: confidence interval).
Figure 3
Figure 3
(a) Forest plot of studies pooled for the risk of severe COVID-19 in PLWH. The red dotted line represents the overall effect size/risk ratio. The lateral edges of the blue diamonds represent the limits of the 95% confidence intervals (RR: risk ratio; CI: confidence interval). (b) Funnel plot of studies pooled for the risk of severe COVID-19 in PLWH (CI: confidence interval).
Figure 4
Figure 4
(a) Forest plot for COVID-19 mortality in PLWH. The red dotted line represents the overall effect size/risk ratio. The lateral edges of the blue diamonds represent the limits of the 95% confidence intervals (RR: risk ratio; CI: confidence interval). (b) Funnel plot of studies pooled for COVID-19 mortality in PLWH (CI: confidence interval).
Figure 4
Figure 4
(a) Forest plot for COVID-19 mortality in PLWH. The red dotted line represents the overall effect size/risk ratio. The lateral edges of the blue diamonds represent the limits of the 95% confidence intervals (RR: risk ratio; CI: confidence interval). (b) Funnel plot of studies pooled for COVID-19 mortality in PLWH (CI: confidence interval).
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