Review Article : Human immunodeficiency virus and mortality from coronavirus disease 2019: A systematic review and meta-analysis

Background:Persons living with human immunodeficiency virus (PLWH) constitute a vulnerable population in view of their impaired immune status. At this time, the full interaction between HIV and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been incompletely described. Objective:The purpose of this study was to explore the impact of HIV and SARS-CoV-2 co-infection on mortality. Method:We systematically searched PubMed and the Europe PMC databases up to 19 January 2021, using specific keywords related to our aims. All published articles on coronavirus disease 2019 (COVID-19) and HIV were retrieved. The quality of the studies was evaluated using the Newcastle–Ottawa Scale for observational studies. Statistical analysis was performed with Review Manager version 5.4 and Comprehensive Meta-Analysis version 3 software. Results:A total of 28 studies including 18 255 040 COVID-19 patients were assessed in this meta-analysis. Overall, HIV was associated with a higher mortality from COVID-19 on random-effects modelling {odds ratio [OR] = 1.19 [95% confidence interval (CI) = 1.01–1.39],p= 0.03;I2= 72%}. Meta-regression confirmed that this association was not influenced by age (p= 0.208), CD4 cell count (p= 0.353) or the presence of antiretroviral therapy (ART) (p= 0.647). Further subgroup analysis indicated that the association was only statistically significant in studies from Africa (OR = 1.13,p= 0.004) and the United States (OR = 1.30,p= 0.006). Conclusion:Whilst all persons ought to receive a SARS-CoV-2 vaccine, PLWH should be prioritised to minimise the risk of death because of COVID-19. The presence of HIV should be regarded as an important risk factor for future risk stratification of COVID-19.