BMC Infectious Diseases (Jun 2022)

Clinical features and outcomes of COVID-19 admissions in a population with a high prevalence of HIV and tuberculosis: a multicentre cohort study

  • Arifa Parker,
  • Linda Boloko,
  • Muhammad S. Moolla,
  • Nabilah Ebrahim,
  • Birhanu T. Ayele,
  • Alistair G. B. Broadhurst,
  • Boitumelo Mashigo,
  • Gideon Titus,
  • Timothy de Wet,
  • Nicholas Boliter,
  • Michael-Jon Rosslee,
  • Nectarios Papavarnavas,
  • Riezaah Abrahams,
  • Marc Mendelson,
  • Sipho Dlamini,
  • Jantjie J. Taljaard,
  • Hans W. Prozesky,
  • Abdurasiet Mowlana,
  • Abraham J. Viljoen,
  • Neshaad Schrueder,
  • Brian W. Allwood,
  • Usha Lalla,
  • Joel A. Dave,
  • Greg Calligaro,
  • Dion Levin,
  • Deborah Maughan,
  • Ntobeko A. B. Ntusi,
  • Peter S. Nyasulu,
  • Graeme Meintjes,
  • Coenraad F. N. Koegelenberg,
  • Ayanda T. Mnguni,
  • Sean Wasserman

DOI
https://doi.org/10.1186/s12879-022-07519-8
Journal volume & issue
Vol. 22, no. 1
pp. 1 – 9

Abstract

Read online

Abstract Background There is still a paucity of evidence on the outcomes of coronavirus disease 2019 (COVID-19) among people living with human immunodeficiency virus (PWH) and those co-infected with tuberculosis (TB), particularly in areas where these conditions are common. We describe the clinical features, laboratory findings and outcome of hospitalised PWH and human immunodeficiency virus (HIV)-uninfected COVID-19 patients as well as those co-infected with tuberculosis (TB). Methods We conducted a multicentre cohort study across three hospitals in Cape Town, South Africa. All adults requiring hospitalisation with confirmed COVID-19 pneumonia from March to July 2020 were analysed. Results PWH comprised 270 (19%) of 1434 admissions. There were 47 patients with active tuberculosis (3.3%), of whom 29 (62%) were PWH. Three-hundred and seventy-three patients (26%) died. The mortality in PWH (n = 71, 26%) and HIV-uninfected patients (n = 296, 25%) was comparable. In patients with TB, PWH had a higher mortality than HIV-uninfected patients (n = 11, 38% vs n = 3, 20%; p = 0.001). In multivariable survival analysis a higher risk of death was associated with older age (Adjusted Hazard Ratio (AHR) 1.03 95%CI 1.02–1.03, p < 0.001), male sex (AHR1.38 (95%CI 1.12–1.72, p = 0.003) and being “overweight or obese” (AHR 1.30 95%CI 1.03–1.61 p = 0.024). HIV (AHR 1.28 95%CI 0.95–1.72, p 0.11) and active TB (AHR 1.50 95%CI 0.84–2.67, p = 0.17) were not independently associated with increased risk of COVID-19 death. Risk factors for inpatient mortality in PWH included CD4 cell count < 200 cells/mm3, higher admission oxygen requirements, absolute white cell counts, neutrophil/lymphocyte ratios, C-reactive protein, and creatinine levels. Conclusion In a population with high prevalence of HIV and TB, being overweight/obese was associated with increased risk of mortality in COVID-19 hospital admissions, emphasising the need for public health interventions in this patient population.

Keywords