Prevalence of HIV in patients hospitalized for COVID-19 and associated mortality outcomes: A systematic review and meta-analysis

ABSTRACT

Background: As of June 3rd, 2020, the number of confirmed cases of novel SARSCoV- 2, the causative agent of COVID-19, was approximately 6,538,456, with 386,503 deaths globally. Individuals with pre-existing conditions are particularly susceptible to and more likely to die from Covid-19. However, individuals with human immunodeficiency virus (HIV) are unique due to their use of antiretroviral therapy, including protease inhibitors, which have been used to treat COVID-19. We aimed to conduct a systematic review and meta-analysis exploring the prevalence and prevalence of HIV in patients hospitalized for COVID-19 and delineating the mortality rates. Methods: MEDLINE, SCOPUS, and Cochrane Library databases and medrxiv. org were searched from January 1st, 2020, to June 15th, 2020. Studies reporting on the prevalence of HIV among hospitalized COVID-19 patients among and outcome of mortality were extracted. Two reviewers independently extracted appropriate data of interest and assessed the risk of bias. All analyses were performed using random-effects models on log-transformed proportions and risk ratio estimates, and heterogeneity was quantified. Results: A total of 144,795 hospitalized COVID-19 patients were identified from 14 studies (United States 8, Spain 3, China 1, Italy1, and Germany 1). The pooled prevalence of HIV in COVID-19 patients was 1.22 % [95% confidence interval (CI) 0.61%-2.43%)] translating to a 2-fold increase compared to the respective local-level pooled HIV prevalence in the general population of 0.65% (95% CI 0.48%-0.89%. When we stratified the analysis by country, pooled HIV prevalence among COVID- 19 patients in United States (1.43%, 95% CI 0.98% -2.07%) was significantly higher compared to Spain (0.26%, 95% CI 0.23%-0.29%) but not different from China (0.99 %, 95% CI 0.25 %-3.85%). The pooled mortality rates in HIV-positive patients hospitalized for COVID-19 was 14.1 % 95% CI 5.78%-30.50% and was substantially higher in the United States compared to other countries. Conclusion: The prevalence of HIV among COVID-19 patients may be higher compared to the general population, suggesting higher susceptibility to COVID-19. The mortality rates are high but vary significantly across countries.