While HIV-positive people are at an increased risk of dying from Covid-19 than those who are HIV-negative, they are at significant less risk than those with other underlying illnesses.
This is according to analysis done by the National Institute for Communicable Diseases (NICD) in the Western Cape, which revealed that people living with HIV were at a “modestly” increased risk of dying from Covid-19, whether the virus is suppressed or not.
However, they are not at a higher risk of dying from Covid-19 than those with other underlying illnesses such as diabetes and hypertension.
The findings were based on data received from adults from the Western Cape between March 1 and June 4.
The NICD used linked data from patients attending public sector health facilities in the Western Cape to identify factors associated with Covid-19 death, including HIV.
“A small proportion (less than 10%) of all Covid-19 deaths in the province were attributable to HIV. Older age, male sex, diabetes mellitus, current and previous tuberculosis, chronic kidney disease and other comorbidities were also associated with increased Covid-19 mortality,” said the NICD.
The Western Cape, with a population of about 7 million, has 520,000 HIV-positive people. More than 90% of these people depend on public sector health services.
Of the surviving and deceased Covid-19 HIV-positive people, 69% and 66% respectively were considered “well on antiretroviral treatment [ART]".
“Covid-19 death was associated with male sex, increasing age and diabetes mellitus (with higher risk with elevated HbA1c), hypertension and chronic kidney disease, as well as previous and current tuberculosis,” the study found.
“After adjusting these factors, there was an increased hazard of Covid-19 death in people living with HIV compared to HIV-negative patients.
“The increased mortality risk was similar in PLWH [people living with HIV] who were 'well on ART' as compared to those who previously started ART but without documented recent viral suppression, or those who had never started ART
It also found that among all public and private sector laboratory-diagnosed Covid-19 cases, there were 97 deaths among an estimated 520,000 HIV-positive people in the province.
“We found approximately twice the risk of Covid-19 death in people with HIV, irrespective of viral suppression or ART use. This increased risk is modest in comparison to the increased risk of Covid-19 death associated with other risk factors such as older age or diabetes.
“Nonetheless, despite a high burden of HIV in the province (16% people living with HIV) in active public sector patients), we have not seen large numbers of patients with advanced HIV and severe Covid-19, and the attributable fraction of all deaths which could be ascribed to HIV is less than 10%.”