Coronavirus Disease 2019 (COVID-19) Outcomes in HIV/AIDS Patients

A Systematic Review

TJ Cooper; BL Woodward; S Alom; A Harky

Disclosures

HIV Medicine. 2020;21(9):567-577. 

In This Article

Abstract and Introduction

Abstract

Objectives: The aim of the study was to systematically review current studies reporting on clinical outcomes in people living with HIV (PLHIV) infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Methods: We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A comprehensive literature search was conducted in Global Health, SCOPUS, Medline and EMBASE using pertinent key words and Medical Subject Headings (MeSH) terms relating to coronavirus disease 2019 (COVID-19) and HIV. A narrative synthesis was undertaken. Articles are summarized in relevant sections.

Results: Two hundred and eighty-five articles were identified after duplicates had been removed. After screening, eight studies were analysed, totalling 70 HIV-infected patients (57 without AIDS and 13 with AIDS). Three themes were identified: (1) controlled HIV infection does not appear to result in poorer COVID-19 outcomes, (2) more data are needed to determine COVID-19 outcomes in patients with AIDS and (3) HIV-infected patients presenting with COVID-19 symptoms should be investigated for superinfections.

Conclusions: Our findings suggest that PLHIV with well-controlled disease are not at risk of poorer COVID-19 disease outcomes than the general population. It is not clear whether those with poorly controlled HIV disease and AIDS have poorer outcomes. Superimposed bacterial pneumonia may be a risk factor for more severe COVID-19 but further research is urgently needed to elucidate whether PLHIV are more at risk than the general population.

Introduction

In December 2019, a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in the city of Wuhan, China. SARS-CoV-2 causes coronavirus disease 2019 (COVID-19), which has resulted in the most catastrophic pandemic in modern history.[1] Presentation can be asymptomatic or consist of mild symptoms, from cough and fever to severe and life-threatening acute respiratory distress syndrome (ARDS), sepsis, multi-organ failure and death.[2] There is no current specific treatment for COVID-19 but rather organ support is provided, and severe cases require admission to hospital for supportive management including mechanical ventilation.

Evidence is emerging that suggests that increasing age, hypertension and diabetes are risk factors that correlate with worse outcomes.[3,4] However, it is not clear if people living with HIV (PLHIV) are at greater risk than the general population.[5] Left untreated, HIV infection results in a reduced number of CD4 T cells, leading to AIDS. AIDS is defined as a CD4 T-cell count < 200 cells/μL[3] or the presence of an AIDS-defining illness.[6] In 2018, it was estimated 37.9 million people worldwide have HIV infection, 23.3 million of whom are on treatment with antiretroviral therapy (ART).[7] Eighty-six per cent of those on treatment have successful viral suppression, resulting in undetectable viral load and untransmissible disease, known as U = U.[8–10] If ART is maintained and adhered to, PLHIV are not immunocompromised.[11] Despite this, PLHIV may be at risk of severe COVID-19, especially in areas where HIV infection is poorly controlled.

Limited evidence is available on the impact of HIV on SARS-CoV-2 infection and on whether it has any effect on COVID-19 outcomes.[12] There is a need to understand whether PLHIV are at greater risk of severe illness so that adequate preventative measures can be put in place.

The aim of this systematic review was to identify studies that discuss PLHIV who have been infected with SARS-CoV-2 and that report whether coinfection results in a greater risk of adverse outcomes and, furthermore, whether controlled HIV infection vs. uncontrolled HIV infection or AIDS results in different COVID-19 disease outcomes. We define controlled HIV infection as an undetectable viral load and a CD4 count ≥ 200 cells/μL.

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