COVID-19 severity and in-hospital mortality in an area with high HIV prevalence

Southern African Journal of HIV Medicine

Field Value
Title COVID-19 severity and in-hospital mortality in an area with high HIV prevalence
Creator Boswell, Michael T. Maimela, Tshegofatso Hameiri-Bowen, Dan Riley, George Malan, Albertus Steyn, Nickietta Nolutshungu, Nomonde de Villiers, Talita R. de Beer, Zelda Mathabathe, John Tshabalala, Khanyisile Abdullah, Fareed Ramlall, Rajiev Heystek, Marthinus Basu, Debashis Rheeder, Paul Ueckermann, Veronica van Hougenhouck-Tulleken, Wesley
Subject Immunology; Medicine; Virology; Healthcare HIV; COVID-19; SARS-CoV-2; mortality; biomarker
Description Background: HIV infection causes immune dysregulation affecting T-cell and monocyte function, which may alter coronavirus disease 2019 (COVID-19) pathophysiology.Objectives: We investigated the associations among clinical phenotypes, laboratory biomarkers, and hospitalisation outcomes in a cohort of people hospitalised with COVID-19 in a high HIV prevalence area.Method: We conducted a prospective observational cohort study in Tshwane, South Africa. Respiratory disease severity was quantified using the respiratory oxygenation score. Analysed biomarkers included inflammatory and coagulation biomarkers, CD4 T-cell counts, and HIV-1 viral loads (HIVVL).Results: The analysis included 558 patients, of whom 21.7% died during admission. The mean age was 54 years. A total of 82 participants were HIV-positive. People living with HIV (PLWH) were younger (mean age 46 years) than HIV-negative people; most were on antiretroviral treatment with a suppressed HIVVL (72%) and the median CD4 count was 159 (interquartile range: 66–397) cells/µL. After adjusting for age, HIV was not associated with increased risk of mortality during hospitalisation (age-adjusted hazard ratio = 1.1, 95% confidence interval: 0.6–2.0). Inflammatory biomarker levels were similar in PLWH and HIV-negative patients. Detectable HIVVL was associated with less severe respiratory disease. In PLWH, mortality was associated with higher levels of inflammatory biomarkers. Opportunistic infections, and other risk factors for severe COVID-19, were common in PLWH who died.Conclusion: PLWH were not at increased risk of mortality and those with detectable HIVVL had less severe respiratory disease than those with suppressed HIVVL.What this study adds: This study advances our understanding of severe COVID-19 in PLWH.
Publisher AOSIS
Contributor None
Date 2023-01-27
Type info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion — —
Format text/html application/epub+zip text/xml application/pdf application/pdf
Identifier 10.4102/sajhivmed.v24i1.1412
Source Southern African Journal of HIV Medicine; Vol 24, No 1 (2023); 10 pages 2078-6751 1608-9693
Language eng
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Coverage South Africa — —
Rights Copyright (c) 2023 Michael T. Boswell, Tshegofatso Maimela, Dan Hameiri-Bowen, George Riley, Albertus Malan, Nickietta Steyn, Nomonde Nolutshungu, Talita R. de Villiers, Zelda de Beer, John Mathabathe, Khanyisile Tshabalala, Fareed Abdullah, Rajiev Ramlall, Marthinus Heyste