TY - JOUR
T1 - The likelihood of severe COVID-19 outcomes among PLHIV with various comorbidities
T2 - a comparative frequentist and Bayesian meta-analysis approach
AU - Wang, Haoyi
AU - Jonas, Kai J.
N1 - © 2021 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.
PY - 2021/11/19
Y1 - 2021/11/19
N2 - INTRODUCTION: 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.METHODS: 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.RESULTS AND DISCUSSION: 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.CONCLUSIONS: 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.
AB - INTRODUCTION: 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.METHODS: 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.RESULTS AND DISCUSSION: 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.CONCLUSIONS: 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.
KW - COHORT
KW - CORONAVIRUS DISEASE 2019
KW - COVID-19
KW - DIABETES-MELLITUS
KW - HIV
KW - HIV-INFECTION
KW - PATHOGENESIS
KW - PEOPLE
KW - PREVALENCE
KW - RISK-FACTORS
KW - comorbidities
KW - corona virus
KW - meta-analysis
U2 - 10.1002/jia2.25841
DO - 10.1002/jia2.25841
M3 - (Systematic) Review article
C2 - 34797952
SN - 1758-2652
VL - 24
JO - Journal of the International AIDS Society
JF - Journal of the International AIDS Society
IS - 11
M1 - e25841
ER -