HIV High Risk For Severe Covid-19 Disease, Death: WHO Study

International AIDS Society president Dr Adeeba Kamarulzaman says the WHO study underscores the need to prioritise people living with HIV for Covid-19 vaccination.

KUALA LUMPUR, July 21 — A new World Health Organization (WHO) report found that HIV appeared to be a significant independent risk factor in-hospital mortality and severe or critical Covid-19 illness upon hospital admission.

This study, which was released on July 15, also found that the risk of developing severe or fatal Covid-19 was 30 per cent more among AIDS patients compared to the general population.

A total of 23.1 per cent of all PLHIV who were hospitalised with Covid-19 died, according to WHO.

Clinical surveillance data collected from 37 countries globally, including 24 countries that provide data on HIV patients, showed that people living with HIV (PLHIV) were at increased risk of severe or critical disease at hospital admission compared to HIV-negative individuals.

This study collected data from a total of 168,649 confirmed or suspected Covid-19 patients. Of them 9.2 per cent or 15,522 people consisted of PLHIV. Majority of PLHIV patients, or 96.1 per cent (14,914 people), belonged to the African region. Of them, 16,682 people or 94.6 per cent of cases were reported in South Africa alone.

This study focused on the impact of HIV infection on severity and mortality associated with Covid-19. Majority of hospitalised Covid-19 patients who also have HIV consisted of females (63 per cent).

They were relatively young, where 49 per cent of them were aged between 18 and 45 years, while 41 percent were aged between 45 and 65 years.

Hypertension (33.2 per cent), diabetes (22.7 per cent) and obesity (16.9 per cent) were the most common underlying conditions among PLHIV.

Among those, 61 per cent reported having one underlying condition, and 28.7 per cent reported two underlying conditions as well as ten per cent had three or more underlying conditions.

According to WHO, PLHIV should be prioritised for Covid-19 vaccination as they have poor immunity to fight coronavirus infection.

International AIDS Society (IAS) president Dr Adeeba Kamarulzaman, who commented on this study, said: “This study underscores the importance of countries, including all people living with HIV, in the list of priority populations for national Covid-19 vaccine programmes.

“The global community must also do much more to bring Covid-19 vaccines to countries around the world with high prevalence of HIV and other diseases. It is unacceptable that as of today, less than three per cent of the entire African continent has received a single dose of the vaccine and less than 1.5 per cent have received both doses,” she mentioned in a statement released by IAS on July 15.

Based on mortality risk analysis according to regions, HIV remained an independent risk factor for death after hospital admission in the WHO African region, but not in the WHO Europe as well as American region.

However, it is to be noted that the number of PLHIV involved in this study from Europe and American region is relatively small compared to the African region.

WHO also emphasised the need for PLHIV to stay as healthy as possible, regularly access and take their antiretroviral (ARV) medications, and prevent and manage underlying conditions.

“This becomes important in stretched health systems where people with HIV may have more severe disease and require more health resources,” Dr Silvia Bertagnolio, an expert on HIV or AIDS from WHO, was quoted as saying in an IAS 2021 press conference on July 18.

Dr Bertagnolio, who referred to the WHO’s recent report, stated that more than one-third of PLHIV (5,563 people) who were admitted to hospital had severe or critical Covid-19. Of these, 35 per cent of patients died.

“There’s a critical need for vaccine equity; in lower- and middle-income countries we have only 3-4% vaccine coverage and we need to get the first dose into everyone,” Dr Meg Doherty, director of WHO’s Global HIV, Hepatitis and STI Programmes, was quoted as saying.

Based on a sensitivity analysis after excluding data received from South Africa, the risk of death in people living with HIV was hospitalised, but was no longer statistically significant due to the limited sample size.

At the same time, an assessment on the relationship between potential risk factors predicting in-hospital mortality revealed that HIV patients aged above 65 years having diabetes and hypertension increased the risk of in-hospital death.

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