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

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 Heystek; Debashis Basu; Paul Rheeder; Veronica Ueckermann; Wesley van Hougenhouck-Tulleken

doi:10.4102/sajhivmed.v24i1.1412

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

South Afr J HIV Med. 2023 Jan 27;24(1):1412. doi: 10.4102/sajhivmed.v24i1.1412. eCollection 2023.

Authors

Michael T Boswell¹, Tshegofatso Maimela², Dan Hameiri-Bowen³, George Riley¹, Albertus Malan⁴, Nickietta Steyn¹, Nomonde Nolutshungu⁵, Talita R de Villiers⁴, Zelda de Beer⁴, John Mathabathe², Khanyisile Tshabalala², Fareed Abdullah⁶, Rajiev Ramlall⁴, Marthinus Heystek⁴, Debashis Basu², Paul Rheeder¹, Veronica Ueckermann¹, Wesley van Hougenhouck-Tulleken¹

Affiliations

¹ Department of Internal Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa.
² Clinical Public Health Unit, Department of Public Health Medicine, Steve Biko Academic Hospital, Pretoria, South Africa.
³ Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom.
⁴ Tshwane District Hospital, Pretoria, South Africa.
⁵ Department of Medical Immunology, University of Pretoria, Pretoria, South Africa.
⁶ South African Medical Research Council, Pretoria, South Africa.

Abstract

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.

Keywords: COVID-19; HIV; SARS-CoV-2; biomarker; mortality.