ABSTRACT
BackgroundThe relationship between HIV infection and COVID-19 clinical outcome is uncertain, with conflicting data and hypotheses. We aimed to assess the prevalence and risk of severe COVID-19 and death in people living with HIV (PLWH) on the global and continental level. MethodsElectronic databases were systematically searched in July 2021. Studies were screened and then extracted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Narratives were synthesised and data pooled for global and continental prevalence and relative risk of severity and mortality in HIV-infected COVID-19 patients using random-effect model. Risk of bias was assessed using the Newcastle-Ottawa score, Eggers test and presented as funnel plots. ResultsA total of 46 studies were included involving 18,034,947 COVID-19 cases of which 31,269 were PLWH. The global prevalence of PLWH with SARS-CoV-2 infection was 1% (95% CI = 0.9% -1.1%) with the highest prevalence observed in sub-Saharan Africa. The relative risk (RR) of COVID-19 severity was significant only in Africa (RR, 95% CI = 1.14, 1.08 - 1.24) while risk of COVID-19 mortality was 1.53% (95% CI = 1.45 - 2.03) globally. The prevalence of PLWH in COVID-19 cases was significantly low, and the calculated global risk ratio show that HIV infection may be linked with increased COVID-19 death. The between-studies heterogeneity was significantly high while risk of publication bias was not significant. ConclusionThere is low prevalence of HIV-SARS-CoV-2 co-infection. HIV infection was linked with severe COVID-19 in Africa and increased risk of death globally.
ABSTRACT
BackgroundReports have suggested a reduction in exacerbations of chronic obstructive pulmonary disease (COPD) during the coronavirus (COVID-19) pandemic, particularly hospital admissions for severe exacerbations. However, the magnitude of this reduction varies between studies. MethodElectronic databases were searched from January 2020 to May 2021. Two independent reviewers screened titles and abstracts and, when necessary, full text to determine if studies met inclusion criteria. A modified version of the Newcastle-Ottawa Scale was used to assess study quality. A narrative summary of eligible studies was synthesised, and meta-analysis was conducted using a random effect model to pool the rate ratio and 95% confidence intervals (95% CI) for hospital admissions. Exacerbation reduction was compared against the COVID-19 Containment and Health Index. ResultsA total of 13 of 745 studies met the inclusion criteria and were included in this review, with data from nine countries. Seven studies could be included in the meta-analysis. The pooled rate ratio of hospital admissions for COPD exacerbations during the pandemic period was 0.50 (95% CI 0.42-0.58). Findings on the rate of community-treated exacerbations were inconclusive. Three studies reported a significant decrease in the incidence of respiratory viral infections compared with the pre-pandemic period. There was not a significant relationship between exacerbation reduction and the COVID-19 Containment and Health Index. ConclusionThere was a 50% reduction in admissions for COPD exacerbations during the COVID-19 pandemic period, associated with a reduction in respiratory viral infections that trigger exacerbations. We provide pooled evidence supporting the potential effectiveness of COVID-19 preventive interventions in reducing the risk of admissions for COPD exacerbations.
ABSTRACT
BackgroundWhile the number of COVID-19 cases and deaths around the world is starting to peak, it is essential to point out how different countries manage the outbreak and how different measures and experience resulted in different outcomes. This study aimed to compare the effect of the measures taken by Saudi Arabia and the United Kingdom (UK) governments on the outcome of the COVID-19 pandemic as predicted by a mathematical model. MethodData on the numbers of cases, deaths and government measures were collected from Saudis Ministry of Health and Public Health England. A prediction of the trend of cases, deaths and days to peak was then modelled using the mathematical technique, Exponential Logistic Growth and Susceptible Infectious Recovered (SIR) model. The measures taken by the governments and the predicted outcomes were compared to assess effectiveness. ResultWe found over three months that 22 fast and extreme measures had been taken in Saudi Arabia compared to eight slow and late measures in the UK. This resulted in a decline in numbers of current infected cases per day and mortality in Saudi Arabia compared to the UK. Based on the SIR model, the predicted number of COVID-19 cases in Saudi as of 31st of March was 2,064, while the predicted number of cases was 63012 in the UK. In addition, the pandemic is predicted to peak earlier on the 27th of March in Saudi Arabia compared to the 2nd of May 2020 in the UK. The end of transition phases for Saudi and UK according to the model, were predicted to be on 18th of April and 24th of May, respectively. These numbers relate to early and decisive measures adopted by the Saudi government. ConclusionWe show that early extreme measures, informed by science and guided by experience, helped reduce the spread and related deaths from COVID-19 in Saudi. Actions were taken by Saudi under the national slogan "We are all responsible" resulted in the observed reduced number of current and predicted cases and deaths compared to the UK approach "keep calm and carry on".
ABSTRACT
BackgroundCoronavirus disease 2019 (COVID-19) is an evolving infectious disease that dramatically spread all over the world in the early part of 2020. No studies have yet summarised the potential severity and mortality risks caused by COVID-19 in patients with chronic obstructive pulmonary disease (COPD), and we update information in smokers. MethodsWe systematically searched electronic databases from inception to March 24, 2020. Data were extracted by two independent authors in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality was assessed using a modified version of the Newcastle-Ottawa Scale. We synthesised a narrative from eligible studies and conducted a meta-analysis using a random-effects model to calculate pooled prevalence rates and 95% confidence intervals (95%CI). ResultsIn total, 123 abstracts were screened and 61 full-text manuscripts were reviewed. A total of 15 studies met the inclusion criteria, which included a total of 2473 confirmed COVID-19 patients. All studies were included in the meta-analysis. The crude case fatality rate of COVID-19 was 6.4%. The pooled prevalence rates of COPD patients and smokers in COVID-19 cases were 2% (95% CI, 1%-3%) and 9% (95% CI, 4%-14%) respectively. COPD patients were at a higher risk of more severe disease (risk of severity = 63%, (22/35) compared to patients without COPD 33.4% (409/1224) [calculated RR, 1.88 (95% CI, 1.4- 2.4)]. This was associated with higher mortality (60%). Our results showed that 22% (31/139) of current smokers and 46% (13/28) of ex-smokers had severe complications. The calculated RR showed that current smokers were 1.45 times more likely [95% CI: 1.03-2.04] to have severe complications compared to former and never smokers. Current smokers also had a higher mortality rate of 38.5%. ConclusionAlthough COPD prevalence in COVID-19 cases was low in current reports, COVID-19 infection was associated with substantial severity and mortality rates in COPD. Compared to former and never smokers, current smokers were at greater risk of severe complications and higher mortality rate. Effective preventive measures are required to reduce COVID-19 risk in COPD patients and current smokers.
