Prevalence of HIV in patients hospitalized for COVID-19 and associated outcomes: a systematic review and meta-analysis

  1. Paddy Ssentongo
  2. Emily S. Heilbrunn
  3. Anna E. Ssentongo
  4. Shailesh Advani
  5. Vernon M. Chinchilli
  6. Jonathan J. Nunez
  7. Ping Du

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Abstract

Objective

To conduct a systematic review and meta-analysis of the prevalence of HIV in patients hospitalized for COVID-19 and delineating clinical outcomes including mortality.

Design/Methods

MEDLINE, SCOPUS, OVID, and Cochrane Library databases and medrxiv.org were searched from January 1st, 2020, to June 15th, 2020. Data were extracted from studies reporting the prevalence of HIV among hospitalized COVID-19 patients and their clinical outcomes.

Analyses were performed using random-effects models on log-transformed proportions and risk ratio estimates, and heterogeneity was quantified.

Results

A total of 144,795 hospitalized COVID-19 patients were identified from 14 studies in North America, Europe, and Asia. Median age was 55 years, and 66% were male. The pooled prevalence of HIV in COVID-19 patients was 1.22% [95% confidence interval (CI): 0.61%-2.43%)] translating to a 2-fold increase compared to the respective local-level pooled HIV prevalence in the general population of 0.65% (95% CI: 0.48%-0.89%). When stratified by country, the pooled HIV prevalence among COVID-19 patients in United States (1.43%, 95% CI: 0.98%–2.07%) was significantly higher compared to Spain (0.26%, 95% CI: 0.23%-0.29%) but was not different from China (0.99%, 95% CI: 0.25%-3.85%). The pooled mortality rate in HIV-positive patients hospitalized for COVID-19 was 14.1% (95% CI: 5.78%-30.50%) and was substantially higher in the United States compared to other countries.

Conclusions

The prevalence of HIV among COVID-19 patients appeared higher than the general population, suggesting a greater susceptibility to COVID-19 for PLWH. The pooled mortality rate is high, but the rates vary significantly across countries.

Suggested Reviewers

Nelson Sewankambo, MD, PhD

Makerere University College of Health Sciences

Opposed Reviewers

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  1. ScreenIT

    SciScore for 10.1101/2020.07.03.20143628: (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
    The present study is being reported in accordance with the reporting guidance provided in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (see PRISMA checklist in Additional file 1).[6] We searched PubMed, Scopus, OVID, Web of Science, Cochrane Library (from January 1st, 2020 to June 7th, 2020).
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    Cochrane Library
    suggested: (Cochrane Library, RRID:SCR_013000)
    We searched the grey or difficult to locate literature, including Google Scholar and Medrxiv.
    Google Scholar
    suggested: (Google Scholar, RRID:SCR_008878)
    Predefined search terms determined by The Medical Subject Headings (MeSH) included multiple combinations of the following: “Human Immunodeficiency Virus” OR “HIV” AND “COVID-19” OR “Coronavirus.” The comprehensive list of studies found as a result of our initial search were transferred into Endnote, which further removed duplicate studies.
    MeSH
    suggested: (MeSH, RRID:SCR_004750)

    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:
    Our study has several strengths and limitations. We provide one of the first evidence of prevalence and mortality among hospitalized COVID-19 patients. Further, we incorporated all available literature to synthesize estimates of the burden of COVID-19 across different regions. However, the contrasting nature and limited evidence of COVID-19 infection rates by comorbidities across regions from Asia and Africa may limit the generalizability of our true estimates. Further, as many studies do not report on the HIV disease status based on their CD4 count and treatment regimen, we could not estimate the severity of COVID-19 infection among HIV positive individuals.

    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.
    • Thank you for including a protocol registration statement.

    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 10.1101/2020.07.03.20143628v1 on medRxiv