A recent Lancet study has shown that human immunodeficiency virus (HIV) and tuberculosis (TB) are associated with an increased risk of COVID-19 in-hospital deaths. Researchers used a national hospital surveillance system with laboratory-confirmed COVID-19 infections for the hospital admissions.

According to the study, COVID-19 in-hospital mortality was definted as a death realted to COVID-19 that occurred during the hospital stay and excluded deaths that occurred due to other causes or once the patient had been discharged.

The study included 13 739 patients with HIV, 5 282 patients with TB and 2 312 patients co-infected with COVID, HIV and TB. It also considered other comorbidities such as diabetes, chronic cardiac disease, hypertension, chronic renal disease; malignancy in the past five years, chronic pulmonary disease and asthma as risk factors for Covid-19-related in-hospital deaths.

Comorbidities an added burden

Dr Norbert Ndjeka, Director for drug-resistant TB, TB, and HIV at the National Department of Health, highlighted the struggled faced by COVID-19 patients living with pre-existing conditions.

“Any comorbidities with COVID-19 is a burden on a person,” said Ndjeka. “It’s a problem because if you are already burdened with tuberculosis, sugar diabetes or high blood pressure and you get COVID-19, it’s not easy.”

ARV therapy crucial

The study which conducted research on 219 265 individuals, also found that people living with HIV and who are not making use of antiretroviral therapy, are more likely to die in hospital than people with HIV on treatment.

According to the 2020 Global AIDS report, patient data from more than 3.4 million South African adults between March and June 2020 shows that people living with HIV had a modestly increased risk of COVID-19 death compared to HIV-negative patients, irrespective of viral suppression.

“If you are a person living with HIV and you stop your antiretroviral therapy, the HIV virus starts to multiply and that is a problem. This causes a higher viral load due to the HIV which is worsened by COVID-19 and its viral load. People living with HIV need to continue taking their ARV medication so the HIV virus can be supressed,” added Ndjeka.

The findings show that among the 219 265 individuals admitted to hospital with confirmed laboratory results of coronavirus infection, 51 037 (23.3%) patients died and 168 228 (76.7%) were discharged.

HIV prevalence among COVID-19 infected patients varied from province to province.

KZN, Mpumalanga top the list

There is a lower prevalence in the Eastern Cape and Gauteng compared to KwaZulu-Natal and Mpumalanga where the prevalence is high.  Comorbidities among people living with HIV stood at 29·2% compared with 30·8% among HIV-uninfected individuals. This means that the increased number of comorbidities was linked with the increase of COVID-19 in-hospital death risk in both people living with HIV and those who are not.

“The risk of not doing well is high. If you have hypertension or sugar diabetes or you just recently started your TB treatment, it’s not the same as a healthy, young body that only has COVID-19 to deal with.  People who have comorbidities are more likely to have complications that may even lead to death,” said Ndjeka.

The study indicated that age, sex, race and ethnicity were considered as potential risk factors for COVID-19 in-hospital mortality. – Health-e News