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Long COVID among people with HIV: A systematic review and meta-analysis
Xueying Yang1,2,3, Fanghui Shi1,2,3, Hao Zhang4
1Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
Insights
People with HIV have a higher risk of long COVID (LC) due to immune issues. This review found 52% of people with HIV experienced LC, highlighting the need for tailored prevention strategies.
Area of Science:
- Immunology
- Infectious Diseases
- Public Health
Background:
- People with HIV (human immunodeficiency virus) may face increased long COVID (LC) risk due to immune dysfunction and chronic inflammation.
- Alterations in immune responses to SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection contribute to this heightened vulnerability.
Purpose of the Study:
- To systematically review the association between HIV infection and LC.
- To determine the prevalence, characteristics, and risk factors of LC among people with HIV.
Main Methods:
- A systematic review of multiple databases (Embase, PubMed, PsycINFO, Web of Science, Sociological Abstracts) was conducted for articles published before June 2023.
- Included studies involved people with HIV and reported at least one LC outcome measure using quantitative or mixed-methods designs.
- Meta-analyses using random-effects models were performed for effects reported in three or more studies.
Main Results:
- The review analyzed 17 studies encompassing 39,405 people with HIV and COVID-19.
- An estimated 52% of people with HIV infected with SARS-CoV-2 developed at least one LC symptom.
- HIV infection was associated with a 2.20-fold increased risk of LC (95% CI 1.25-3.86). Common symptoms included cough, fatigue, and asthenia. Risk factors identified included moderate-severe COVID-19, elevated inflammatory markers (IFN-γ, TNF-α), and reduced IFN-β.
Conclusions:
- The COVID-19 pandemic exacerbates health inequities for people with HIV due to their elevated LC risk.
- Findings are crucial for public health and clinical professionals to develop targeted strategies for preventing and managing LC in this population.
Background:
People with HIV might be at an increased risk of long COVID (LC) because of their immune dysfunction and chronic inflammation and alterations in immunological responses against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2; coronavirus disease 2019 [COVID-19]). This systematic review aimed to evaluate the association between HIV infection and LC and the prevalence and characteristics of and risk factors for LC among people with HIV.
Methods:
Multiple databases, including Embase, PubMed, PsycINFO, Web of Science, and Sociological Abstracts, were searched to identify articles published before June 2023. Published articles were included if they presented at least one LC outcome measure among people with HIV and used quantitative or mixed-methods study designs. For effects reported in three or more studies, meta-analyses using random-effects models were performed using R software.
Results:
We pooled 39 405 people with HIV and COVID-19 in 17 eligible studies out of 6158 publications in all the databases. It was estimated that 52% of people with HIV with SARS-CoV-2 infection developed at least one LC symptom. Results from the random-effects model showed that HIV infection was associated with an increased risk of LC (odds ratio 2.20; 95% confidence interval 1.25-3.86). The most common LC symptoms among people with HIV were cough, fatigue, and asthenia. Risk factors associated with LC among people with HIV included a history of moderate-severe COVID-19 illness, increased interferon-gamma-induced protein 10 or tumour necrosis factor-α, and decreased interferon-β, among others.
Conclusions:
The COVID-19 pandemic continues to exacerbate health inequities among people with HIV because of their higher risk of developing LC. Our review is informative for public health and clinical communities to develop tailored strategies to prevent aggravated LC among people with HIV.
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