Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands.
J Int AIDS Soc. 2021 Nov;24(11):e25841. doi: 10.1002/jia2.25841.
The SARS-CoV-2 virus can currently pose a serious health threat and can lead to severe COVID-19 outcomes, especially for populations suffering from comorbidities. Currently, the data available on the risk for severe COVID-19 outcomes due to an HIV infection with or without comorbidities paint a heterogenous picture. In this meta-analysis, we summarized the likelihood for severe COVID-19 outcomes among people living with HIV (PLHIV) with or without comorbidities.
Following PRISMA guidelines, we utilized PubMed, Web of Science and medRxiv to search for studies describing COVID-19 outcomes in PLHIV with or without comorbidities up to 25 June 2021. Consequently, we conducted two meta-analyses, based on a classic frequentist and Bayesian perspective of higher quality studies.
We identified 2580 studies (search period: January 2020-25 June 2021, data extraction period: 1 January 2021-25 June 2021) and included nine in the meta-analysis. Based on the frequentist meta-analytical model, PLHIV with diabetes had a seven times higher risk of severe COVID-19 outcomes (odd ratio, OR = 6.69, 95% CI: 3.03-19.30), PLHIV with hypertension a four times higher risk (OR = 4.14, 95% CI: 2.12-8.17), PLHIV with cardiovascular disease an odds ratio of 4.75 (95% CI: 1.89-11.94), PLHIV with respiratory disease an odds ratio of 3.67 (95% CI: 1.79-7.54) and PLHIV with chronic kidney disease an OR of 9.02 (95% CI: 2.53-32.14) compared to PLHIV without comorbidities. Both meta-analytic models converged, thereby providing robust summative evidence. The Bayesian meta-analysis produced similar effects overall, with the exclusion of PLHIV with respiratory diseases who showed a non-significant higher risk to develop severe COVID-19 outcomes compared to PLHIV without comorbidities.
Our meta-analyses show that people with HIV, PLHIV with coexisting diabetes, hypertension, cardiovascular disease, respiratory disease and chronic kidney disease are at a higher likelihood of developing severe COVID-19 outcomes. Bayesian analysis helped to estimate small sample biases and provided predictive likelihoods. Clinical practice should take these risks due to comorbidities into account and not only focus on the HIV status alone, vaccination priorities should be adjusted accordingly.
SARS-CoV-2 病毒目前可能对健康构成严重威胁，并可能导致严重的 COVID-19 结果，尤其是对患有合并症的人群。目前，关于 HIV 感染合并或不合并合并症导致严重 COVID-19 结果的风险的数据描绘了一幅异质的图景。在这项荟萃分析中，我们总结了合并或不合并合并症的 HIV 感染者（PLHIV）发生严重 COVID-19 结果的可能性。
根据 PRISMA 指南，我们利用 PubMed、Web of Science 和 medRxiv 搜索了截至 2021 年 6 月 25 日描述合并或不合并合并症的 PLHIV COVID-19 结果的研究。因此，我们根据高质量研究的经典频率主义和贝叶斯观点进行了两项荟萃分析。
我们确定了 2580 项研究（搜索期：2020 年 1 月至 2021 年 6 月 25 日，数据提取期：2021 年 1 月 1 日至 2021 年 6 月 25 日），其中 9 项纳入荟萃分析。基于频率主义荟萃分析模型，患有糖尿病的 PLHIV 发生严重 COVID-19 结果的风险高 7 倍（比值比，OR = 6.69，95%CI：3.03-19.30），患有高血压的 PLHIV 风险高 4 倍（OR = 4.14，95%CI：2.12-8.17），患有心血管疾病的 PLHIV 风险高 4.75 倍（OR = 4.75，95%CI：1.89-11.94），患有呼吸道疾病的 PLHIV 风险高 3.67 倍（OR = 3.67，95%CI：1.79-7.54），患有慢性肾脏疾病的 PLHIV 风险高 9.02 倍（OR = 9.02，95%CI：2.53-32.14）与无合并症的 PLHIV 相比。两种荟萃分析模型都收敛了，从而提供了有力的综合证据。贝叶斯荟萃分析总体上产生了类似的效果，除了患有呼吸道疾病的 PLHIV 与无合并症的 PLHIV 相比，发生严重 COVID-19 结果的风险没有显著增加。
我们的荟萃分析表明，HIV 感染者、合并糖尿病、高血压、心血管疾病、呼吸道疾病和慢性肾脏疾病的 PLHIV 发生严重 COVID-19 结果的可能性更高。贝叶斯分析有助于估计小样本偏差并提供预测可能性。临床实践应考虑到合并症带来的这些风险，而不仅仅关注 HIV 状况本身，相应地调整疫苗接种优先级。
