The Interaction between HIV Infection and COVID-19: A Systematic Review and Meta-Analysis

Background: The evidence on the impact of HIV on COVID-19 is insufficient and inconsistent. This study synthesized the risk of SARS-CoV-2 infection, severe COVID-19 symptoms and COVID-19 related mortality among people living with HIV (PLWH). Methods: We conducted a systematic review and meta-analysis by searching PubMed, medRxiv and Cochrane between December 1st , 2019 to September 18th, 2020 for original studies, published in English, on HIV-SARS-CoV-2 co-infected patients. We extracted individual-level data from case reports/series and summarized patients’ characteristics and clinical outcomes. Studies were assessed for bias using NOS. Risk of SARS-CoV-2 infection, severe COVID-19 and mortality were pooled at 95% CI. Risk ratio was used to compare the risk between PLWH and patients without HIV. Findings: We identified 2,464 articles and included 61 of them. The pooled SARS-CoV-2 infection rate among PLWH was 1·5% (95% CI 0·7%- 3·2%) and there was a higher infection rate compared to people without HIV (RR 1·17, 95% CI 1·13- 1·21). The pooled rate of severe COVID-19 symptoms was 23·8% (95% CI, 14·7%- 36·1%) for PLWH, comparable to people without HIV (RR 1·32, 95% CI, 0·76-2·30). The pooled fatality rate among PLWH was 9·4% (95% CI 5·4%-15·8%). The crude RR between PLWH and patients without HIV is comparable (RR 1·02, 95% CI 0·90-1·16) but an increased COVID-19 mortality risk among PLWH was observed after adjust for potential confounders (adjusted RR 2·07, 95% CI 1·73%- 2·47%). Interpretation: Local health system should strengthen COVID-19 prevention and treatment among PLWH, and sustain the HIV care continuum for PLWH. Funding: This work was supported by the National Key Research and Development Program of China (2017YFE0103800), NIMH (R34MH109359 and R34MH119963), National Science and Technology Major Project (2018ZX10101-001-001-003), and the National Nature Science Foundation of China (81903371). Declaration of Interests: The authors had no conflict of interest to disclose.