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Observational Study
. 2023 Feb 28;23(1):123.
doi: 10.1186/s12879-023-08004-6.

The clinical and epidemiological characteristics of a series of patients living with HIV admitted for COVID-19 in a district hospital

Ayanda Trevor Mnguni  1   2 , Denzil Schietekat  2 , Nabilah Ebrahim  2 , Nawhaal Sonday  2 , Nicholas Boliter  2 , Neshaad Schrueder  1 , Shiraaz Gabriels  1 , Lovemore N Sigwadhi  3 , Annalise E Zemlin  4 , Zivanai C Chapanduka  5 , Veranyuy Ngah  3 , Anteneh Yalew  3 , Thumeka Jalavu  4 , Ibtisam Abdullah  5   6 , Jacques L Tamuzi  3 , Yamanya Tembo  7 , Mary-Ann Davies  8   9   7 , Rene English  10 , Peter S Nyasulu  11   12
Affiliations
Observational Study

The clinical and epidemiological characteristics of a series of patients living with HIV admitted for COVID-19 in a district hospital

Ayanda Trevor Mnguni et al. BMC Infect Dis. .

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic continues to evolve. Globally, COVID-19 continues to strain even the most resilient healthcare systems, with Omicron being the latest variant. We made a thorough search for literature describing the effects of the COVID-19 in a high human immunodeficiency virus (HIV)/tuberculosis (TB) burden district-level hospital setting. We found scanty literature.

Methods: A retrospective observational study was conducted at Khayelitsha District Hospital in Cape Town, South Africa (SA) over the period March 2020-December 2021. We included confirmed COVID-19 cases with HIV infection aged from 18 years and above. Analysis was performed to identify predictors of mortality or hospital discharge among people living with HIV (PLWH). Predictors investigated include CD4 count, antiretroviral therapy (ART), TB, non-communicable diseases, haematological, and biochemical parameters.

Findings: This cohort of PLWH with SARS-CoV-2 infection had a median (IQR) age of 46 (37-54) years, male sex distribution of 29.1%, and a median (IQR) CD4 count of 267 (141-457) cells/mm3. Of 255 patients, 195 (76%) patients were discharged, 60 (24%) patients died. One hundred and sixty-nine patients (88%) were on ART with 73(28%) patients having acquired immunodeficiency syndrome (AIDS). After multivariable analysis, smoking (risk ratio [RR]: 2.86 (1.75-4.69)), neutrophilia [RR]: 1.024 (1.01-1.03), and glycated haemoglobin A1 (HbA1c) [RR]: 1.01 (1.007-1.01) were associated with mortality.

Conclusion: The district hospital had a high COVID-19 mortality rate among PLWH. Easy-to-access biomarkers such as CRP, neutrophilia, and HbA1c may play a significant role in informing clinical management to prevent high mortality due to COVID-19 in PLWH at the district-level hospitals.

Keywords: COVID-19; District hospital; HIV; PLWH; SARS-CoV-2; TB.

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Conflict of interest statement

No conflict of interest declared.

Figures

Fig. 1
Fig. 1
Map of the district of Khayelitsha in Cape Town
Fig. 2
Fig. 2
ROC curve for Neutrophils between death and discharged COVID-19 cases with HIV infection
Fig. 3
Fig. 3
ROC curve for CRP between death and discharged COVID-19 cases with HIV infection
Fig. 4
Fig. 4
Kaplan–Meier plot for overall survival among COVID-19 males and females with HIV co-infection
Fig. 5
Fig. 5
Plots of the scaled Schoenfeld residuals of each covariate between males and females
See this image and copyright information in PMC

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