Global and Regional Prevalence and Outcomes of COVID-19 in People Living with HIV: A Systematic Review and Meta-Analysis

  1. Tope Oyelade
  2. Jaber S. Alqahtani
  3. Ahmed M. Hjazi
  4. Amy Li
  5. Ami Kamila
  6. Reynie Purnama Raya

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Abstract

Background: The relationship between HIV (human immunodeficiency virus) and COVID-19 clinical outcome is uncertain, with conflicting data and hypotheses. We aimed to assess the prevalence of people living with HIV (PLWH) among COVID-19 cases and whether HIV infection affects the risk of severe COVID-19 or related death at the global and continental level. Methods: Electronic databases were systematically searched in July 2021. In total, 966 studies were screened following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Narratives were synthesised and data pooled for the global and continental prevalence of HIV–SARS-CoV-2 coinfection. The relative risks of severity and mortality in HIV-infected COVID-19 patients were computed using a random-effect model. Risk of bias was assessed using the Newcastle–Ottawa score and Egger’s test, and presented as funnel plots. Results: In total, 43 studies were included involving 692,032 COVID-19 cases, of whom 9097 (1.3%) were PLWH. The global prevalence of PLWH among COVID-19 cases was 2% (95% CI = 1.7–2.3%), with the highest prevalence observed in sub-Saharan Africa. The relative risk (RR) of severe COVID-19 in PLWH was significant only in Africa (RR = 1.14, 95% CI = 1.05–1.24), while the relative risk of mortality was 1.5 (95% CI = 1.45–2.03) globally. The calculated global risk showed that HIV infection may be linked with increased COVID-19 death. The between-study heterogeneity was significantly high, while the risk of publication bias was not significant. Conclusions: Although there is a low prevalence of PLWH among COVID-19 cases, HIV infection may increase the severity of COVID-19 in Africa and increase the risk of death globally.

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  1. Version published to 10.3390/tropicalmed7020022
  2. ScreenIT

    SciScore for 10.1101/2021.07.12.21260361: (What is this?)

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

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Following the Preferred Reporting in Systematic Reviews and Meta-Analyses (PRISMA) guidelines (17), Medline and Embase databases were searched on 2nd of July 2021 using keywords and MeSH terms (Fig.
    Medline
    suggested: (MEDLINE, RRID:SCR_002185)
    Embase
    suggested: (EMBASE, RRID:SCR_001650)
    MeSH
    suggested: (MeSH, RRID:SCR_004750)
    Studies retrieved from the search were imported into EndNote software and the duplicates removed.
    EndNote
    suggested: (EndNote, RRID:SCR_014001)
    To further assess publication bias in the studies pooled for prevalence and the risk of severity and mortality in PLWH-COVID-19, funnel plots and Egger test were computed using ‘metafunnel’ and ‘metabias’ procedures respectively in STATA.
    STATA
    suggested: (Stata, RRID:SCR_012763)

    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:
    This study has several limitations. Firstly, some of the included studies are case series reporting only the PLWH co-infected with SARS-CoV-2. Such studies were excluded from the prevalence analysis, and this may explain the high heterogeneity in the results. However, the random effect model was used to account for the variations in experimental design. Secondly, most studies did not report the distributions of comorbidities, race, age, CD4 and CD8 counts, duration of HIV infection, ART use among other confounders in the studied groups. Thus, we could not control for these parameters in this study. Also, most studies did not report the clinical outcomes (death and severity) of COVID-19 in both PLWH and patients who are HIV-negative and could not be included in the relative risk computation. However, the Egger’s test and funnel plots show that there is no publication bias in the analysed data. Our findings have several clinical and research implications. First, it further widens the body of evidence by including more recent studies to report that PLWH may be at an increased risk of severe COVID-19 and death and which regions may be mostly at risk. Secondly, we show that the risk of severe COVID-19 and death in PLWH varies between continents and may reflect a complex interplay of concomitant contributory factors which may need to be controlled for to better understand the direct or total effect of HIV infection on COVID-19 outcome. Also, the prevalence of HIV-SARS-CoV-2 coinfec...

    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.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2021.07.12.21260361v1 on medRxiv