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

• Published in: Tropical medicine and infectious disease 2022-02, Vol.7 (2), p.22
• Main Authors: Oyelade, Tope, Alqahtani, Jaber S, Hjazi, Ahmed M, Li, Amy, Kamila, Ami, Raya, Reynie Purnama
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; AIDS; Coronaviruses; COVID-19; Fatalities; HIV; Human immunodeficiency virus; infectious disease; Meta-analysis; Mortality; pandemic; public health; Systematic Review
• ISSN: 2414-6366; 2414-6366
• DOI: 10.3390/tropicalmed7020022

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. 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. 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. 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.