Covid-19 among adults living with HIV: Correlates of mortality among public sector healthcare users in Western Cape, South Africa
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Date
2023
Journal Title
Journal ISSN
Volume Title
Publisher
Wiley
Abstract
Introduction: While a large proportion of people with HIV (PWH) have experienced SARS-CoV-2 infections, there is uncertainty
about the role of HIV disease severity on COVID-19 outcomes, especially in lower-income settings. We studied the
association of mortality with characteristics of HIV severity and management, and vaccination, among adult PWH.
Methods: We analysed observational cohort data on all PWH aged ≥15 years experiencing a diagnosed SARS-CoV-2 infection
(until March 2022), who accessed public sector healthcare in the Western Cape province of South Africa. Logistic regression
was used to study the association of mortality with evidence of antiretroviral therapy (ART) collection, time since first HIV
evidence, CD4 cell count, viral load (among those with evidence of ART collection) and COVID-19 vaccination, adjusting for
demographic characteristics, comorbidities, admission pressure, location and time period.
Results: Mortality occurred in 5.7% (95% CI: 5.3,6.0) of 17,831 first-diagnosed infections. Higher mortality was associated
with lower recent CD4, no evidence of ART collection, high or unknown recent viral load and recent first HIV evidence,
differentially by age. Vaccination was protective. The burden of comorbidities was high, and tuberculosis (especially more
recent episodes of tuberculosis), chronic kidney disease, diabetes and hypertension were associated with higher mortality,
more strongly in younger adults.
Description
Keywords
Covid-19, Public health, Public sector, Western Cape, Statistics, Bioinformatics
Citation
Kassanjee, R. et al. (2023). Covid-19 among adults living with HIV: Correlates of mortality among public sector healthcare users in Western Cape, South Africa. Journal of the International AIDS Society, 26(6), e26104. 10.1002/jia2.26104