COVID-19 Resource Center
COVID-19 Resource Center
Source/Disclosures
Disclosures: Boulle reports receiving grants from the Bill and Melinda Gates Foundation, NIH and the Wellcome Trust and nonfinancial support from the United States Agency for International Development. Please see the study for all other authors’ relevant financial disclosures.
September 03, 2020
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HIV, TB associated with increased COVID-19 mortality in South African study

Source/Disclosures
Disclosures: Boulle reports receiving grants from the Bill and Melinda Gates Foundation, NIH and the Wellcome Trust and nonfinancial support from the United States Agency for International Development. Please see the study for all other authors’ relevant financial disclosures.
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HIV and tuberculosis were independently associated with an increased risk for COVID-19 mortality in a South African study that included more than 22,000 patients with the new disease, researchers reported in Clinical Infectious Diseases.

“While the HIV and tuberculosis-associated increased risk of COVID-19 death may be over-estimated if there is residual confounding due to socioeconomic status or unrecorded comorbidities, our results, supported by sensitivity analyses, demonstrate that [people with HIV] and persons with tuberculosis are at increased risk of severe COVID-19,” Andrew Boulle, of the University of Cape Town’s School of Public Health and Family Medicine, and colleagues wrote.

COVID-19 mortality and HIV infographic
Source: Boulle A, et al. Clin Infect Dis. 2020;doi:10.1093/cid/ciaa1198.

Boulle and colleagues conducted a population cohort study that included data from more than 3.4 million adults who attended public health sector facilities in Western Cape, South Africa. They analyzed the connections between HIV, TB and COVID-19 mortality between March 1, 2020, and June 9, 2020. They included active patients, defined as patients with one or more visits in the 3 years before March 2020, laboratory-diagnosed COVID-19 cases and hospitalized COVID-19 cases.

Of the patients analyzed, 16% were HIV positive and 22,308 had a COVID-19 diagnosis, of whom 625 (2.8%) died. HIV was associated with COVID-19 mortality (adjusted HR = 2.14; 95% CI, 1.7-2.7), as was previous (aHR = 1.51; 95% CI, 1.18-1.93) and current (aHR = 2.7; 95% CI, 1.81-4.04) TB.

COVID-19 death was also associated with increasing age, diabetes, hypertension, chronic kidney disease and male sex.

Boule and colleagues found that, among patients with HIV who were on ART, tenofovir disoproxil fumarate was associated with lower COVID-19 mortality compared with other antiretrovirals.

Other studies have found that COVID-19 outcomes are not worse among patients with HIV.