Factors affecting poor prognosis of COVID-19 in people living with human immunodeficiency virus: A systematic review and meta-analysis of co-infection

Objectives: This study aims to assess the correlation between clinical features and mortality in human immunodeficiency virus (HIV)-infected individuals with COVID-19.

Methods: A systematic literature search was conducted for cohort, cross-sectional, and case series that reported co-infection with HIV and COVID-19 published from January to September 2020. Clinical features such as age, comorbidities, CD4⁺T lymphocyte counts, HIV RNA levels, and antiretroviral regimens were evaluated using meta-analyses and systematic reviews. Meta-analysis was performed using Stata 15.0 software.

Results: A total of 24 articles with 939 cases of HIV/COVID-19 co-infection were included in this study. The overall mortality rate was 10.3% (97/939). Older age and comorbidities including hypertension, diabetes, renal insufficiency, chronic obstructive pulmonary disease/asthma, and tumors were significantly associated with increased mortality (95% confidence interval 0.005–0.050, 0.042–2.294, 0.390–2.754, 0.513–2.848, 0.348–3.743, and 1.943–7.101, respectively, P = 0.021, 0.043, 0.012, 0.008, 0.022, and 0.005). There was no significant correlation between mortality and CD4⁺T lymphocyte count <200/μL or >500/μL, HIV RNA level below the detection limit, or antiretroviral drugs (including tenofovir) (all P > 0.05). Improved HIV treatment, complex immune interactions, study population variability, and lack of direct SARS-CoV-2 targeting by ART likely obscure the correlation between CD4⁺ counts or ART and COVID-19 mortality in HIV patients.

Conclusion: HIV-infected individuals with COVID-19 have a similar prognosis to the general population. However, older age, comorbidities (hypertension and diabetesetc.), and lower CD4⁺ T-cell counts are associated with increased mortality. Mainstream anti-HIV drugs do not offer significant protection against COVID-19.

• Population(s)
  • General HIV+ population