Risk of adverse coronavirus disease 2019 outcomes for people living with HIV.
Risk of adverse coronavirus disease 2019 outcomes for people living with HIV.
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DOI：
10.1097/qad.0000000000002836
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发表时间：
2021-03-15
期刊：
影响因子：
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通讯作者：
Dorward J
中科院分区：
文献类型：
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作者：
Mellor MM;Bast AC;Jones NR;Roberts NW;Ordóñez-Mena JM;Reith AJM;Butler CC;Matthews PC;Dorward J
评估艾滋病毒感染者（PLWH）是否面临2019冠状病毒病（COVID-19）死亡或不良后果的风险增加，以及抗逆转录病毒治疗（ART）是否会影响这种风险。通过荟萃分析和叙述性综合进行快速审查。我们检索了截至2020年8月26日的数据库，包括Embase、Medline、medRxiv和Google Scholar，以查找描述PLWH中COVID-19结局的研究，并对高质量研究进行了荟萃分析。我们确定了1908项研究，并将19项纳入综述。在对五项研究的荟萃分析中，与未感染艾滋病毒的人相比，PLWH的COVID-19死亡风险更高[风险比1.95，95%置信区间（CI）：1.62-2.34]。在住院队列的亚组分析（风险比1.60，95% CI：1.12-2.27）和所有环境中的PLWH研究（风险比2.08，95% CI：1.69-2.56）中，PLWH的死亡风险仍然升高。其他8项研究评估了艾滋病毒和COVID-19结果之间的关联，但由于潜在的混杂和选择偏倚，提供了不确定的、质量较低的证据。关于CD 4 + T细胞计数和HIV病毒载量对COVID-19结果的影响，数据不足。11项研究报告了ART方案的COVID-19结局。在两项最大的研究中，基于替诺福韦酯的方案与COVID-19不良结局的风险较低相关，尽管这些分析容易受到合并症的混淆。新出现的证据表明，艾滋病毒感染者的COVID-19死亡风险适度增加。需要进一步研究COVID-19结局与CD 4 + T细胞计数、HIV病毒载量、ART和富马酸替诺福韦酯使用之间的关系。
To assess whether people living with HIV (PLWH) are at increased risk of coronavirus disease 2019 (COVID-19) mortality or adverse outcomes, and whether antiretroviral therapy (ART) influences this risk. Rapid review with meta-analysis and narrative synthesis. We searched databases including Embase, Medline, medRxiv and Google Scholar up to 26 August 2020 for studies describing COVID-19 outcomes in PLWH and conducted a meta-analysis of higher quality studies. We identified 1908 studies and included 19 in the review. In a meta-analysis of five studies, PLWH had a higher risk of COVID-19 mortality [hazard ratio 1.95, 95% confidence interval (CI): 1.62–2.34] compared with people without HIV. Risk of death remained elevated for PLWH in a subgroup analysis of hospitalized cohorts (hazard ratio 1.60, 95% CI: 1.12–2.27) and studies of PLWH across all settings (hazard ratio 2.08, 95% CI: 1.69–2.56). Eight other studies assessed the association between HIV and COVID-19 outcomes, but provided inconclusive, lower quality evidence due to potential confounding and selection bias. There were insufficient data on the effect of CD4+ T-cell count and HIV viral load on COVID-19 outcomes. Eleven studies reported COVID-19 outcomes by ART-regimen. In the two largest studies, tenofovir disoproxil fumarate-based regimens were associated with a lower risk of adverse COVID-19 outcomes, although these analyses are susceptible to confounding by co-morbidities. Emerging evidence suggests a moderately increased risk of COVID-19 mortality among PLWH. Further investigation into the relationship between COVID-19 outcomes and CD4+ T-cell count, HIV viral load, ART and the use of tenofovir disoproxil fumarate is warranted.