Does HIV impact susceptibility to COVID-19 (SARS-CoV-2) infection and pathology? A review of the current literature

  1. Elnara Aghakishiyeva
  2. Derek Macallan

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

Objectives

Giving appropriate guidance to people living with HIV (PLWH) during the COVID-19 pandemic depends on having adequate data to inform recommendations. Several studies have now been published which inform such advice. The objective of this study was to collate this information and review the implications of emerging data.

Methods

We performed a systematic literature search of studies relating COVID-19 to HIV infection from the beginning of the pandemic to end of November 2020. We included both published and pre-published manuscripts and analysed papers according to whether they primarily informed risk of infection or risk of adverse outcome.

Results

68 papers (including 11 pre-prints) were identified. In terms of risk of infection, it appears that PLWH are no more or less likely to become infected with COVID-19. In terms of outcomes and mortality, most early small studies did not demonstrate an increase in mortality compared to background populations. However, several larger, more recent studies from South Africa, New York and two from the UK demonstrate higher mortality among PLWH when results are adjusted for other risk factors, giving relative risks of 2.1, 1.2, 1.7 and 2.3 respectively. Apparently conflicting results may arise from differences between studies in their power to account for cofactors and confounding variables. HIV-positive non-survivors tend to be younger and have fewer comorbidities than their HIV-negative counterparts; mortality may be higher in PLWH with low CD4 counts.

Conclusions

Although the literature appears conflicting, large studies which account for covariates strongly suggest that HIV infection increases COVID-19 mortality.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2020.12.04.20240218: (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 identified studies using keywords, ‘COVID-19’, ‘coronavirus disease-19’, ‘SARS-CoV-2’, ‘novel coronavirus’, ‘new coronavirus’, ‘severe acute respiratory syndrome coronavirus 2’, ‘people living with HIV’, ‘HIV/ AIDS’, ‘co-infection’, ‘immunosuppression’ in electronic databases: PubMed, Google Scholar and ScienceDirect, as well as direct searches in specific journals: The Lancet, JAMA, The BMJ, NEJM, Clinical Infectious Diseases, The Journal of Infectious Diseases.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    Google Scholar
    suggested: (Google Scholar, RRID:SCR_008878)
    Therefore, the same search terms were used to search for literature on the preprint servers, Medrxiv and Biorxiv.
    Biorxiv
    suggested: (bioRxiv, RRID:SCR_003933)

    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:
    The caveat to this conclusion is that PLWH may have been shielding or otherwise reducing their exposure (reducing the factor, α) during the pandemic, in which case, true infection risk may be higher than estimated. In terms of severity, early studies were reassuring. PLWH did not appear over-represented among those experiencing complications with COVID-19. However, it is now apparent that, when adjusted for other risk factors, even well-controlled HIV infection does appear associated with increased mortality risk. Indeed, much of the disparity between the findings of different studies can be accounted for by the way in which authors have accounted (or not) for co-factors and confounders in their models. Almost all studies that have considered comorbidities have found that the same factors operate within HIV-positive COVID-19-infected cohorts as have been identified in the general population (age, cardiovascular disease, obesity etc), as might be expected. Taking co-factors into account is not possible in small studies, but larger studies allow adjustment which may be crucial for interpretation. So, for example, in Geretti et al (21) and Bhaskaran et al, (20) unadjusted mortality rates in PLWH are no higher than background mortality rates. However, in both studies, once data are adjusted for age etc, the independent adverse impact of HIV infection is evident. This increased mortality risk with HIV infection manifests itself in different parts of the patient pathway in differen...

    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 10.1101/2020.12.04.20240218v1 on medRxiv