Does HIV impact susceptibility to COVID-19 (SARS-CoV-2) infection and pathology? A review of the current literature

Objectives Giving appropriate guidance to people living with HIV (PLWH) during the COVID-19 pandemic depends on having adequate data to inform recommendations. Several studies have now been published which inform such advice. The objective of this study was to collate this information and review the implications of emerging data. Methods We performed a systematic literature search of studies relating COVID-19 to HIV infection from the beginning of the pandemic to end of November 2020. We included both published and pre-published manuscripts and analysed papers according to whether they primarily informed risk of infection or risk of adverse outcome. Results 68 papers (including 11 pre-prints) were identified. In terms of risk of infection, it appears that PLWH are no more or less likely to become infected with COVID-19. In terms of outcomes and mortality, most early small studies did not demonstrate an increase in mortality compared to background populations. However, several larger, more recent studies from South Africa, New York and two from the UK demonstrate higher mortality among PLWH when results are adjusted for other risk factors, giving relative risks of 2.1, 1.2, 1.7 and 2.3 respectively. Apparently conflicting results may arise from differences between studies in their power to account for cofactors and confounding variables. HIV-positive non-survivors tend to be younger and have fewer comorbidities than their HIV-negative counterparts; mortality may be higher in PLWH with low CD4 counts. Conclusions Although the literature appears conflicting, large studies which account for covariates strongly suggest that HIV infection increases COVID-19 mortality.