Risk of adverse coronavirus disease 2019 outcomes for people living with HIV

  1. Maya M. Mellor
  2. Anne C. Bast
  3. Nicholas R. Jones
  4. Nia W. Roberts
  5. José M. Ordóñez-Mena
  6. Alastair J.M. Reith
  7. Christopher C. Butler
  8. Philippa C. Matthews
  9. Jienchi Dorward

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Abstract

To assess whether people living with HIV (PLWH) are at increased risk of coronavirus disease 2019 (COVID-19) mortality or adverse outcomes, and whether antiretroviral therapy (ART) influences this risk.

Design:

Rapid review with meta-analysis and narrative synthesis.

Methods:

We searched databases including Embase, Medline, medRxiv and Google Scholar up to 26 August 2020 for studies describing COVID-19 outcomes in PLWH and conducted a meta-analysis of higher quality studies.

Results:

We identified 1908 studies and included 19 in the review. In a meta-analysis of five studies, PLWH had a higher risk of COVID-19 mortality [hazard ratio 1.95, 95% confidence interval (CI): 1.62–2.34] compared with people without HIV. Risk of death remained elevated for PLWH in a subgroup analysis of hospitalized cohorts (hazard ratio 1.60, 95% CI: 1.12–2.27) and studies of PLWH across all settings (hazard ratio 2.08, 95% CI: 1.69–2.56). Eight other studies assessed the association between HIV and COVID-19 outcomes, but provided inconclusive, lower quality evidence due to potential confounding and selection bias. There were insufficient data on the effect of CD4 + T-cell count and HIV viral load on COVID-19 outcomes. Eleven studies reported COVID-19 outcomes by ART-regimen. In the two largest studies, tenofovir disoproxil fumarate-based regimens were associated with a lower risk of adverse COVID-19 outcomes, although these analyses are susceptible to confounding by co-morbidities.

Conclusion:

Emerging evidence suggests a moderately increased risk of COVID-19 mortality among PLWH. Further investigation into the relationship between COVID-19 outcomes and CD4 + T-cell count, HIV viral load, ART and the use of tenofovir disoproxil fumarate is warranted.

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  1. ScreenIT

    SciScore for 10.1101/2020.09.22.20199661: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We searched Embase, Medline, medRxiv, LitCovid, Trip, Google and Google Scholar without language restrictions.
    Embase
    suggested: (EMBASE, RRID:SCR_001650)
    Medline
    suggested: (MEDLINE, RRID:SCR_002185)
    Google
    suggested: (Google, RRID:SCR_017097)
    Google Scholar
    suggested: (Google Scholar, RRID:SCR_008878)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: Our meta-analysis of five studies is potentially limited by the small numbers of PLWH with COVID-19 who died. This presented challenges when accounting for confounding; studies that used multivariable analyses to adjust for confounding were susceptible to over-fitting of models and potential over-adjustment by factors which could be on the causal pathway between HIV and death (e.g. malignancy or tuberculosis). Studies that used matching were potentially under-powered, which may explain why they tended to report no independent association between HIV and COVID-19 death. In our narrative synthesis, the majority of the studies were small case series or cohort studies that did not adequately account for confounders such as age. Most were performed in high-income countries, and the majority of participants had well-controlled HIV on ART. This may limit the applicability to populations of PLWH in other settings. Only 68% of adults and 53% of children living with HIV globally are receiving ART [42], highlighting a crucial need to examine the risk of COVID-19 complications in these populations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1097/qad.0000000000002836
  3. Version published to 10.1101/2020.09.22.20199661v1 on medRxiv