{"id":38266,"date":"2020-06-26T07:36:50","date_gmt":"2020-06-26T07:36:50","guid":{"rendered":"http:\/\/i-base.info\/htb\/?p=38266"},"modified":"2020-06-26T09:50:04","modified_gmt":"2020-06-26T09:50:04","slug":"update-on-western-cape-data-showing-people-with-hiv-have-small-increase-in-risk-of-poor-outcomes-from-covid-19","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/38266","title":{"rendered":"Update on Western Cape data: people with HIV have small increased risks from COVID-19"},"content":{"rendered":"

<\/b>Polly Clayden, HIV i-Base<\/span><\/strong><\/p>\n

Routine public sector data from Western Cape South Africa, showing a modestly increased risk of mortality from COVID-19 among people living with HIV (and the largest assessment of SARS-CoV-2 and HIV coinfected people to date), were presented on a webinar and widely-reported earlier in June. [1, 2]<\/span><\/strong><\/p>\n

These data have been slightly updated and published on 22 June 2020 by the National Institute for Communicable Diseases. [3]<\/span><\/p>\n

Between 1 March and 4 June 2020, there were 12,522 people, aged 20 and above, diagnosed with COVID-19 and alive at the time of analysis and 435 COVID-19 deaths.<\/span><\/p>\n

The proportion of men was lower among COVID-19 cases vs non-cases (30% vs 42%) \u2013 the authors suggest that this was likely due to early cases occurring in essential workers in sectors largely employing women.<\/span><\/p>\n

Slightly higher proportions of COVID-19 cases had diabetes mellitus (13% vs 8%), hypertension (20% vs 16%) and HIV (18% vs 16%).\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0<\/span><\/p>\n

COVID-19 patients who died were considerably older than those who survived: median 63 years (IQR 54 to 71) vs 37 (IQR 30 to 48).<\/span><\/p>\n

Of the people with HIV and COVID-19 who died and survived, 69% and 66% were considered \u201cwell on ART\u201d (by the definition of the analysis).<\/span><\/p>\n

The authors also looked at whether the association <\/span>between HIV and COVID-19 mortality could be associated with unmeasured confounding eg by socio-economic status or raised BMI \u2013 which was not captured in the analysis.<\/p>\n

They calculated the E-value for an unmeasured confounder for both above analyses. This value is an estimate of how strong the association between a confounder and the outcome would need to be to account for all of the association between, in this case, HIV and COVID-19 death.<\/p>\n

They found the E-value for analysis among all public sector patients to be 4.94 (3.60 for the lower bound of the CI). This suggests that there would need to be a strong association between both HIV and low socio-economic status (or raised BMI), and COVID-19 death to account for all the association between HIV and COVID-19 death.<\/p>\n

Among all public and private sector diagnosed COVID-19 cases, there were 97 deaths among an estimated population of approximately 520,000 people with HIV in the Western Cape province (187 deaths\/million) vs 573 deaths among 6.36 million people without HIV (90 deaths\/million).<\/p>\n

The SMR for COVID-19 mortality in people with HIV, relative to HIV negative people, was 2.33 (95% CI 1.83 to 2.91) and 8.2% (95% CI: 5.3 to 11.2) of deaths were considered to be associated with HIV.<\/p>\n

comment<\/span><\/h3>\n

Although the published findings do not differ from those presented earlier by webinar, it is worth reading the more comprehensive data set.<\/span><\/strong><\/p>\n

And it is important that the authors have now looked at potential unmeasured confounding for the association between HIV and COVID-19 in this setting. <\/span><\/strong><\/p>\n

This article was first published online on 25 June 2020.<\/em><\/span><\/p>\n

References<\/span><\/p>\n

    \n
  1. Davies MA et al.<\/span> Western Cape: COVID-19 and HIV\/Tuberculosis. Webinar: when epidemics collide. Bhekisisa Centre for Health Journalism. 9 June 2020.<\/span>
    \nhttps:\/\/bhekisisa.org\/multimedia\/2020-06-09-standing-by-when-epidemics-collide-does-hiv-tb-cause-worse-covid-19\/<\/a> (webinar)<\/span>
    \n    https:\/\/storage.googleapis.com\/stateless-bhekisisa-website\/wordpress-uploads\/2020\/06\/94d3ea42-covid_update_bhekisisa_wc_3.pdf<\/a> (Mary-Ann Davies\u2019 presentation pdf)<\/span><\/li>\n
  2. Clayden P. HIV positive people in South Africa at increased risk of dying from COVID-19: first data from country with high prevalence of HIV and TB. HTB.17 June 2020.<\/span>
    \n    https:\/\/i-base.info\/htb\/38232<\/a><\/span><\/li>\n
  3. Davies MA et al. Risk of COVID-19 death among people with HIV: a population cohort analysis from the Western Cape province, South Africa. Covid-19 special public health surveillance bulletin. 22 June 2020.
    \n<\/span>    https:\/\/www.nicd.ac.za\/wp-content\/uploads\/2020\/06\/COVID-19-Special-Public-Health-Surveillance-Bulletin-22-June-2020.pdf<\/a> (PDF)<\/span><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Polly Clayden, HIV i-Base Routine public sector data from Western Cape South Africa, showing a modestly increased risk of mortality from COVID-19 among people living with HIV (and the largest assessment of SARS-CoV-2 and HIV coinfected people to date), were …<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[282,278],"tags":[],"class_list":["post-38266","post","type-post","status-publish","format-standard","hentry","category-covid-19-hiv-and-covid-19-coinfection","category-covid-19"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/38266","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=38266"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/38266\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=38266"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=38266"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=38266"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}