Impact of HIV infection on the manifestations and outcomes of COVID-19 in selected tertiary Hospitals in Tanzania
Authors: Osati Elisha F. O. , Sangeda Raphael , Nagu Tumaini , Shayo Grace 
Published: January 2024

Abstract
Background

Outcomes of severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) coinfection with human immunodeficiency virus (HIV) have been reported with conflicting results, leaving a gray zone in understanding this coexistence. We investigated the impact of HIV infection on COVID-19 disease severity and its outcomes in a Tanzanian population.

Methods and Findings

A retrospective study was designed to include adult patients aged 18 years or older admitted with SARS‑CoV‑2 infection from 26th March 2021 to 30th September 2022. Archived data of patients with confirmed SARS‑CoV‑2 infection and documented HIV status admitted to five tertiary-level hospitals in Tanzania were perused. Information collected included sociodemographic, baseline radiological and clinical characteristics, including HIV status. Admission outcomes were also recorded. The mean (SD) or median (IQR) was used to summarize continuous variables. Means were compared using t tests, and medians were compared using Mann‒Whitney tests. Categorical data are presented using proportions and were compared using the chi-square test or Fisher's exact test. P values < 0.05 were considered significant.

Results

Out of 1387 COVID-19 patients, 52% were male, and 87 (6%) were HIV-infected. The mean (SD) age was 50 (±12.3) years for HIV-infected patients vs. 61 (±16.2) years for HIV-uninfected patients. Headache (27% vs. 18%, p= 0.04), productive cough (14% vs. 8%, p = 0.03), wheezing (7% vs. 3%, p = 0.02), abdominal pain (15% vs. 7%, p = 0.006), past history of TB (18% vs. 1.3%, p<0.001), and previous history of stroke (4.6% vs. 1.3%, p<0.001) were significantly more prevalent among HIV-infected than HIV-uninfected COVID-19 patients. D-dimer [10.9 (5.0, 95.2) μ/mL vs. 3.3 (2.4, 4.1) μ/mL, p=<0.001] and hemoglobin [11 (10.2, 11.8) g/dl vs. 12.6 (12.4, 12.7) g/dl, p=<0.001] were significantly more deranged among HIV-infected patients than among HIV-uninfected patients. A respiratory rate of more than 30 breaths per minute was more frequent in the HIV-infected patients (23% vs. 12%, p = 0.004). Mortality was significantly higher in HIV-infected patients than in HIV-uninfected patients (54% vs. 34%), respectively, p <0.001.

Conclusions

HIV-infected patients with COVID-19 were a decade younger than HIV-uninfected patients. Headache, productive cough, wheezing and abdominal pain were more significant in HIV-infected than HIV-uninfected COVID-19 patients. D-dimer and hemoglobin were significantly higher among HIV-infected patients. A previous history of stroke and past TB were the most common comorbidities among HIV-infected patients. Hypertension and diabetes mellitus were the most common comorbidities among HIV-uninfected patients. Severe COVID-19 was significantly more common among HIV-infected patients than HIV-uninfected patients. Over half of HIV-infected patients died of COVID-19 compared to a third of HIV-uninfected patients. HIV-infected patients, particularly those with previous stroke or past TB, should be prioritized for COVID-19 prevention measures such as vaccination and early comprehensive treatments.