COVID-19 among adults living with HIV: correlates of mortality among public sector healthcare users in Western Cape,South Africa |
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| Authors: | Reshma Kassanjee Mary-Ann Davies Olina Ngwenya Richard Osei-Yeboah Theuns Jacobs Erna Morden Venessa Timmerman Stefan Britz Marc Mendelson Jantjie Taljaard Julien Riou Andrew Boulle Nicki Tiffin Nesbert Zinyakatira |
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| Affiliation: | 1. School of Public Health, University of Cape Town, Cape Town, South Africa;2. Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa;3. Division of Computational Biology, Integrative Biomedical Sciences Department, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa;4. Department of Health, Western Cape Government, Cape Town, South Africa;5. School of Public Health, University of Cape Town, Cape Town, South Africa Department of Health, Western Cape Government, Cape Town, South Africa;6. Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa;7. Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa;8. Division of Infectious Diseases, Department of Medicine, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa;9. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland;10. South African National Bioinformatics Institute, University of the Western Cape, Cape Town, South Africa |
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| Abstract: | Introduction While a large proportion of people with HIV (PWH) have experienced SARS-CoV-2 infections, there is uncertainty about the role of HIV disease severity on COVID-19 outcomes, especially in lower-income settings. We studied the association of mortality with characteristics of HIV severity and management, and vaccination, among adult PWH. Methods We analysed observational cohort data on all PWH aged ≥15 years experiencing a diagnosed SARS-CoV-2 infection (until March 2022), who accessed public sector healthcare in the Western Cape province of South Africa. Logistic regression was used to study the association of mortality with evidence of antiretroviral therapy (ART) collection, time since first HIV evidence, CD4 cell count, viral load (among those with evidence of ART collection) and COVID-19 vaccination, adjusting for demographic characteristics, comorbidities, admission pressure, location and time period. Results Mortality occurred in 5.7% (95% CI: 5.3,6.0) of 17,831 first-diagnosed infections. Higher mortality was associated with lower recent CD4, no evidence of ART collection, high or unknown recent viral load and recent first HIV evidence, differentially by age. Vaccination was protective. The burden of comorbidities was high, and tuberculosis (especially more recent episodes of tuberculosis), chronic kidney disease, diabetes and hypertension were associated with higher mortality, more strongly in younger adults. Conclusions Mortality was strongly associated with suboptimal HIV control, and the prevalence of these risk factors increased in later COVID-19 waves. It remains a public health priority to ensure PWH are on suppressive ART and vaccinated, and manage any disruptions in care that occurred during the pandemic. The diagnosis and management of comorbidities, including for tuberculosis, should be optimized. |
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| Keywords: | HIV SARS-CoV-2 COVID-19 mortality CD4 count South Africa |
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