Original Research

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
Southern African Journal of HIV Medicine | Vol 24, No 1 | a1412 | DOI: https://doi.org/10.4102/sajhivmed.v24i1.1412 | © 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 | This work is licensed under CC Attribution 4.0
Submitted: 24 July 2022 | Published: 27 January 2023

About the author(s)

Michael T. Boswell, Department of Internal Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
Tshegofatso Maimela, Clinical Public Health Unit, Department of Public Health Medicine, Steve Biko Academic Hospital, Pretoria, South Africa
Dan Hameiri-Bowen, Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
George Riley, Department of Internal Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
Albertus Malan, shwane District Hospital, Pretoria, South Africa
Nickietta Steyn, Department of Internal Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
Nomonde Nolutshungu, Department of Medical Immunology, University of Pretoria, Pretoria, South Africa
Talita R. de Villiers, Tshwane District Hospital, Pretoria, South Africa
Zelda de Beer, Tshwane District Hospital, Pretoria, South Africa
John Mathabathe, Clinical Public Health Unit, Department of Public Health Medicine, Steve Biko Academic Hospital, Pretoria, South Africa
Khanyisile Tshabalala, Clinical Public Health Unit, Department of Public Health Medicine, Steve Biko Academic Hospital, Pretoria, South Africa
Fareed Abdullah, South African Medical Research Council, Pretoria, South Africa
Rajiev Ramlall, Tshwane District Hospital, Pretoria, South Africa
Marthinus Heystek, Tshwane District Hospital, Pretoria, South Africa
Debashis Basu, Clinical Public Health Unit, Department of Public Health Medicine, Steve Biko Academic Hospital, Pretoria, South Africa
Paul Rheeder, Department of Internal Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
Veronica Ueckermann, Department of Internal Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
Wesley van Hougenhouck-Tulleken, Department of Internal Medicine, Steve Biko Academic Hospital, University of Pretoria, 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

HIV; COVID-19; SARS-CoV-2; mortality; biomarker

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Crossref Citations

1. Are persons living with diagnosed HIV capable of mounting a strong inflammatory response to the new coronavirus?
Anna Maro, Elizabeth M. Rosenthal, Marie Abdallah, James Tesoriero, Jack Dehovitz
International Journal of STD & AIDS  vol: 34  issue: 13  first page: 978  year: 2023  
doi: 10.1177/09564624231191814