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.
Highlights
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
Prior studies have identified that older age or underlying comorbidities such as cancer, diabetes, cardiovascular disease, hypertension, heart failure, chronic kidney disease, and obesity increased the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and mortality from COVID-192–5
There is a growing concern that the immunosuppressing nature of HIV4 may make people living with HIV/ AIDS (PLWHA) more susceptible to SARS-CoV-2 infection and more likely to present with severe COVID-19 when infected
Summary
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. Prior studies have identified that older age or underlying comorbidities such as cancer, diabetes, cardiovascular disease, hypertension, heart failure, chronic kidney disease, and obesity increased the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and mortality from COVID-192–5. With nearly 40 million PLWHA across the globe, it remains urgent to characterize the epidemiology and outcomes of COVID-19 such as intensive care unit (ICU) admission, mechanical ventilation, and death among this g roup[9] To address this knowledge gap, we conducted a systematic review and meta-analysis of the literature to (1) assess the risk of SARS-CoV-2 infection among PLWHA and (2) estimate the mortality risk from COVID-19 for PLWHA
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