Journal article
Risk of adverse coronavirus disease 2019 outcomes for people living with HIV
- Abstract:
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Objective: To assess whether people living with HIV (PLWH) are at increased risk of 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 26th August 2020 for studies describing COVID-19 outcomes in PLWH and conducted a meta-analysis of higher quality studies. Results: We identified 1,908 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 (HR) 1.95, 95% Confidence Interval (CI): 1.62-2.34) compared to people without HIV. Risk of death remained elevated for PLWH in a subgroup analysis of hospitalised cohorts (HR 1.60, 95% CI: 1.12-2.27) and studies of PLWH across all settings (HR 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 (TDF)-based regimens were associated with a lower risk of adverse COVID-19 outcomes, although these analyses are susceptible to confounding by comorbidities.
Conclusion: Emerging evidence suggests a moderately increased risk of COVID-19 mortality amongst PLWH. Further investigation into the relationship between COVID-19 outcomes and CD4+ T cell count, HIV viral load, ART and the use of TDF is warranted.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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- Files:
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(Preview, Version of record, pdf, 281.4KB, Terms of use)
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- Publisher copy:
- 10.1097/QAD.0000000000002836
Authors
- Publisher:
- Lippincott, Williams and Wilkins
- Journal:
- AIDS More from this journal
- Volume:
- 35
- Issue:
- 4
- Pages:
- F1-F10
- Publication date:
- 2021-03-15
- Acceptance date:
- 2021-01-27
- DOI:
- EISSN:
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1473-5571
- ISSN:
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0269-9370
- Language:
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English
- Keywords:
- Pubs id:
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1161681
- Local pid:
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pubs:1161681
- Deposit date:
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2021-02-16
- ARK identifier:
Terms of use
- Copyright holder:
- Mellor et al.
- Copyright date:
- 2021
- Rights statement:
- © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
- Licence:
- CC Attribution (CC BY)
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