Study finds increased risk of death from COVID-19 for people living with HIV and TB
People living with HIV and TB in South Africa are 2.75 and 2.5 times respectively more likely to die from COVID-19 – but this risk is much lower than for age and diabetes.
Preliminary data on the interaction between COVID-19 and HIV and tuberculosis (TB) shows an increased risk of COVID-19 death for people living with HIV, and those with active or a previous history of TB.
Although much is known about other risk factors including age and certain non-communicable diseases like diabetes and high blood pressure, until now limited data has existed about the outcomes of COVID-19 for people living with HIV and TB.
Researchers noted that they still lacked complete data to better understand what drives the increased risk of death in these groups – including information on socio-economic status and obesity, which may also play a part.
The findings come from an analysis by the Western Cape Department of Health of 3.5 million people receiving public health care in the province, currently the epicentre of South Africa’s COVID-19 outbreak. Researchers collected data from all recorded COVID-19 deaths in the public sector, including information on underlying morbidities. They then looked at the factors associated with COVID-19 death in connection with each of the morbidities.
While the data confirms findings from previous studies that age and certain non-communicable diseases increase the chance of dying from COVID-19, it also shows that people living with HIV have a 2.75 times increased risk compared to people not living with HIV. For people with active TB, this is slightly lower at a 2.5 times increased risk compared to those without TB, and there’s a small increased risk of death for people with previous TB.
Significantly, researchers found that the increased risk of death for people living with HIV was the same for those on treatment and virally suppressed as those who were not on treatment or virally suppressed. Previously, it was assumed that any increased risk would be driven by people not being on treatment and therefore having a compromised immune system. However, more research is needed to understand this fully.
Although the data shows an increased risk from COVID-19 for those living with HIV or TB, researchers stressed that it is still much smaller than for other known risk factors, such as age and other comorbidities. For every 100 people who have died from COVID-19 in the Western Cape Province, 52 had diabetes and 19 had high blood pressure, while 12 out of 100 people who died had HIV and 6 currently or previously had TB.
Researchers also noted that the risk could be overestimated if they haven’t fully disentangled all comorbidities and risks that drive death. This includes obesity and socio-economic status, which are not included in the results but may be significant risk factors. Another important factor to consider is that people living with HIV and TB in this region are typically younger, and therefore tend to have a low overall risk of death from COVID-19.
Reflecting on the results, Mary-Ann Davies, Epidemiology and Surveillance Specialist at the Western Cape Department of Health, said: “What’s new from our data is that we’ve been able to quantify the effect of HIV and TB [on COVID-19 outcomes], which until now we haven’t known. We might have expected that effect to really be very large but in fact what we’re seeing is a fairly modest (around 2.5 times) increased risk of COVID death with these conditions.”
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