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ObjectiveTo conduct a systematic review and meta-analysis of the prevalence of HIV in patients hospitalized for COVID-19 and delineating clinical outcomes including mortality. Design/MethodsMEDLINE, SCOPUS, OVID, and Cochrane Library databases and medrxiv.org were searched from January 1st, 2020, to June 15th, 2020. Data were extracted from studies reporting the prevalence of HIV among hospitalized COVID-19 patients and their clinical outcomes. Analyses were performed using random-effects models on log-transformed proportions and risk ratio estimates, and heterogeneity was quantified. ResultsA total of 144,795 hospitalized COVID-19 patients were identified from 14 studies in North America, Europe, and Asia. Median age was 55 years, and 66% were male. 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 stratified by country, the 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 was not different from China (0.99%, 95% CI: 0.25%-3.85%). The pooled mortality rate 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. ConclusionsThe prevalence of HIV among COVID-19 patients appeared higher than the general population, suggesting a greater susceptibility to COVID-19 for PLWH. The pooled mortality rate is high, but the rates vary significantly across countries. Suggested ReviewersNelson Sewankambo, MD, PhD Makerere University College of Health Sciences Opposed Reviewers
ABSTRACT
ObjectiveThe association between renin-angiotensin-aldosterone (RAAS) inhibitors and Coronavirus diseases 2019 (COVID-19) mortality is unclear. We aimed to explore the association of RAAS inhibitors, including angiotensin-converting inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) with COVID-19 mortality in patients with hypertension. MethodsMEDLINE, SCOPUS, OVID, and Cochrane Library were searched for the period of January 1, 2020 to May 20, 2020. Studies reporting the association of RAAS inhibitors (ACEi and ARBs) and mortality in patients with hypertension, hospitalized for COVID-19 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 risk ratio estimates, and heterogeneity was quantified. ResultsData were collected on 2,065,805 individuals (mean age, 58.73 years; 53.4% male). Patients with hypertension taking RAAS inhibitors were 35% less likely to die from COVID-19 compared to patients with hypertension not taking RAAS inhibitors (pooled RR= 0.65, 95% Confidence Intervals (CI): 0.45-0.94). To explore the association of COVID-19 and specific classes of RAAS inhibitors, we conducted a subgroup analysis of ARBs and ACEi separately from studies that provided them. Pooled risk ratio estimates from ARBs and ACEi showed a lower but not significant risk of death from COVID-19 (RR=0.93, 95% CI: 0.70-1.22) and ACEi (RR=0.65, 95% CI: 0.32-1.30). ConclusionsIn this meta-analysis, it was discovered that taking RAAS inhibitors, significantly decreased the risk of COVID-19 mortality in patients with hypertension. This indicates a potential protective role that RAAS-inhibitors may have in COVID-19 patients with hypertension. Key QuestionsO_ST_ABSWhat is already known about this subject?C_ST_ABSSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the recent coronavirus disease 2019 (COVID-19) pandemic, interfaces with the renin-angiotensin-aldosterone system (RAAS) through angiotensin-converting enzyme 2 (ACE2). Recent studies have questioned whether RAAS inhibitors are safe in patients with COVID-19. However, observational studies involving patients hospitalized with COVID-19 that report the association of RAAS-inhibitors and COVID-19 severity or death have yielded conflicting findings. What does this study add?This systematic review and meta-analysis discovered that RAAS inhibitors reduced the risk of mortality by 35% in patients with hypertension hospitalized for COVID-19 (RR= 0.65, 95% CI 0.45-0.94). How might this impact clinical practice?Patients taking RAAS-inhibitors to manage their hypertension should continue to do as per current treatment guidelines.
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BackgroundExploring the association of coronavirus-2019 disease (COVID-19) mortality with chronic pre-existing conditions may promote the importance of targeting these populations during this pandemic to optimize survival. The objective of this systematic review and meta-analysis is to explore the association of pre-existing conditions with COVID-19 mortality. MethodsWe searched MEDLINE, OVID databases, SCOPUS, and medrxiv.org for the period December 1, 2019, to May 1, 2020. The outcome of interest was the risk of COVID-19 mortality in patients with and without pre-existing conditions. Comorbidities explored were cardiovascular diseases (coronary artery disease, hypertension, cardiac arrhythmias, and congestive heart failure), chronic obstructive pulmonary disease, type 2 diabetes, cancer, chronic kidney disease, chronic liver disease, and stroke. Two independent reviewers extracted data and assessed the risk of bias. All analyses were performed using random-effects models and heterogeneity was quantified. ResultsTen chronic conditions from 19 studies were included in the meta-analysis (n = 61,455 patients with COVID-19; mean age, 61 years; 57% male). Overall the between-study study heterogeneity was medium and studies had low publication bias and high quality. Coronary heart disease, hypertension, congestive heart failure, and cancer significantly increased the risk of mortality from COVID-19. The risk of mortality from COVID-19 in patients with coronary heart disease was 2.4 times as high as those without coronary heart disease (RR= 2.40, 95%CI=1.71-3.37, n=5) and twice as high in patients with hypertension as high as that compared to those without hypertension (RR=1.89, 95%CI= 1.58-2.27, n=9). Patients with cancer also were at twice the risk of mortality from COVID-19 compared to those without cancer (RR=1.93 95%CI 1.15-3.24, n=4), and those with congestive heart failure were at 2.5 times the risk of mortality compared to those without congestive heart failure (RR=2.66, 95%CI 1.58-4.48, n=3). ConclusionsCOVID-19 patients with all any cardiovascular disease, coronary heart disease, hypertension, congestive heart failure, and cancer have an increased risk of mortality. Tailored infection prevention and treatment strategies targeting this high-risk population are warranted to optimize survival.
