@article{Kassanjee2022,
abstract = {Introduction: While a large proportion of people with HIV (PWH) have experienced SARS-CoV-2 infections, there is uncertainty about the role of HIV disease severity on COVID-19 outcomes, especially in lower income settings. We studied the association between mortality and characteristics of HIV severity and management, and vaccination, among adult PWH. Methods: We analysed observational cohort data on all PWH aged ≥15 years experiencing a diagnosed SARS-CoV-2 infection (until March 2022), who accessed public sector healthcare in the Western Cape province of South Africa. Logistic regression was used to study the association of mortality with CD4 cell count, viral load, evidence of ART, time since first HIV evidence, and vaccination, adjusting for demographic characteristics, comorbidities, admission pressure, location and time period. Results: Mortality occurred in 5.7{\%} (95{\%} CI: 5.3,6.0) of 17 831 first diagnosed infections. Higher mortality was associated with lower recent CD4, no evidence of ART collection, high or unknown recent viral load (among those with ART evidence), and recent first HIV evidence, differentially by age. Vaccination was protective. The burden of comorbidities was high, and tuberculosis, chronic kidney disease, diabetes and hypertension were associated with higher mortality, more strongly in younger adults. Conclusions: Mortality was strongly associated with suboptimal HIV control, and prevalence of these risk factors increased in later COVID-19 waves. It remains a public health priority to ensure PWH are on suppressive ART and vaccinated, and manage any disruptions in care that occurred during the pandemic. The diagnosis and management of comorbidities, including for tuberculosis, should be optimised. {\#}{\#}{\#} Competing Interest Statement The authors have declared no competing interest. {\#}{\#}{\#} Funding Statement We acknowledge funding for the Western Cape Provincial Health Data Centre from the Western Cape Department of Health, the US National Institutes for Health (R01 HD080465, U01 AI069924), the Bill and Melinda Gates Foundation (1164272, 1191327), the United States Agency for International Development (72067418CA00023), the European Union (101045989) and the Grand Challenges ICODA pilot initiative delivered by Health Data Research UK and funded by the Bill {\&} Melinda Gates and Minderoo Foundations (INV-017293). Funding was also received from Wellcome Trust (203135/Z/16/Z, 222574). The funders had no role in the study design, data collection, data analysis, data interpretation, or writing of this report. The opinions, findings and conclusions expressed in this manuscript reflect those of the authors alone. {\#}{\#}{\#} Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Health Research Ethics committee of the University of Cape Town, and the Western Cape Government Provincial Department of Health, gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The data are not publicly available due to privacy or ethical restrictions. The data that support the findings of this study can be requested from the Western Cape Provincial Health Data Centre (WCPHDC) [https://www.westerncape.gov.za/general-publication/provincial-health-data-centre]; restrictions apply to the availability of these data.},
author = {Kassanjee, Reshma and Davies, Mary-Ann and Ngwenya, Olina and Osei-Yeboah, Richard and Jacobs, Theuns and Morden, Erna and Timmerman, Venessa and Britz, Stefan and Mendelson, Marc and Taljaard, Jantjie and Riou, Julien and Boulle, Andrew and Tiffin, Nicki and Zinyakatira, Nesbert},
doi = {10.1101/2022.10.17.22281085},
file = {:C$\backslash$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Kassanjee et al. - 2022 - COVID-19 among adults living with HIV Correlates of mortality in a general population in a resource-limited se.pdf:pdf},
isbn = {10.1101/2022.10.1},
journal = {medRxiv},
keywords = {OA,fund{\_}ack,genomics{\_}fund{\_}ack,original},
mendeley-tags = {OA,fund{\_}ack,genomics{\_}fund{\_}ack,original},
month = {oct},
pages = {2022.10.17.22281085},
publisher = {Cold Spring Harbor Laboratory Press},
title = {{COVID-19 among adults living with HIV: Correlates of mortality in a general population in a resource-limited setting}},
url = {https://www.medrxiv.org/content/10.1101/2022.10.17.22281085v1 https://www.medrxiv.org/content/10.1101/2022.10.17.22281085v1.abstract},
year = {2022}
}

{"_id":"aeKhmCoQ3DfoHq8Ls","bibbaseid":"kassanjee-davies-ngwenya-oseiyeboah-jacobs-morden-timmerman-britz-etal-covid19amongadultslivingwithhivcorrelatesofmortalityinageneralpopulationinaresourcelimitedsetting-2022","author_short":["Kassanjee, R.","Davies, M.","Ngwenya, O.","Osei-Yeboah, R.","Jacobs, T.","Morden, E.","Timmerman, V.","Britz, S.","Mendelson, M.","Taljaard, J.","Riou, J.","Boulle, A.","Tiffin, N.","Zinyakatira, N."],"bibdata":{"bibtype":"article","type":"article","abstract":"Introduction: While a large proportion of people with HIV (PWH) have experienced SARS-CoV-2 infections, there is uncertainty about the role of HIV disease severity on COVID-19 outcomes, especially in lower income settings. We studied the association between mortality and characteristics of HIV severity and management, and vaccination, among adult PWH. Methods: We analysed observational cohort data on all PWH aged ≥15 years experiencing a diagnosed SARS-CoV-2 infection (until March 2022), who accessed public sector healthcare in the Western Cape province of South Africa. Logistic regression was used to study the association of mortality with CD4 cell count, viral load, evidence of ART, time since first HIV evidence, and vaccination, adjusting for demographic characteristics, comorbidities, admission pressure, location and time period. Results: Mortality occurred in 5.7% (95% CI: 5.3,6.0) of 17 831 first diagnosed infections. Higher mortality was associated with lower recent CD4, no evidence of ART collection, high or unknown recent viral load (among those with ART evidence), and recent first HIV evidence, differentially by age. Vaccination was protective. The burden of comorbidities was high, and tuberculosis, chronic kidney disease, diabetes and hypertension were associated with higher mortality, more strongly in younger adults. Conclusions: Mortality was strongly associated with suboptimal HIV control, and prevalence of these risk factors increased in later COVID-19 waves. It remains a public health priority to ensure PWH are on suppressive ART and vaccinated, and manage any disruptions in care that occurred during the pandemic. The diagnosis and management of comorbidities, including for tuberculosis, should be optimised. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement We acknowledge funding for the Western Cape Provincial Health Data Centre from the Western Cape Department of Health, the US National Institutes for Health (R01 HD080465, U01 AI069924), the Bill and Melinda Gates Foundation (1164272, 1191327), the United States Agency for International Development (72067418CA00023), the European Union (101045989) and the Grand Challenges ICODA pilot initiative delivered by Health Data Research UK and funded by the Bill & Melinda Gates and Minderoo Foundations (INV-017293). Funding was also received from Wellcome Trust (203135/Z/16/Z, 222574). The funders had no role in the study design, data collection, data analysis, data interpretation, or writing of this report. The opinions, findings and conclusions expressed in this manuscript reflect those of the authors alone. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Health Research Ethics committee of the University of Cape Town, and the Western Cape Government Provincial Department of Health, gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The data are not publicly available due to privacy or ethical restrictions. The data that support the findings of this study can be requested from the Western Cape Provincial Health Data Centre (WCPHDC) [https://www.westerncape.gov.za/general-publication/provincial-health-data-centre]; restrictions apply to the availability of these data.","author":[{"propositions":[],"lastnames":["Kassanjee"],"firstnames":["Reshma"],"suffixes":[]},{"propositions":[],"lastnames":["Davies"],"firstnames":["Mary-Ann"],"suffixes":[]},{"propositions":[],"lastnames":["Ngwenya"],"firstnames":["Olina"],"suffixes":[]},{"propositions":[],"lastnames":["Osei-Yeboah"],"firstnames":["Richard"],"suffixes":[]},{"propositions":[],"lastnames":["Jacobs"],"firstnames":["Theuns"],"suffixes":[]},{"propositions":[],"lastnames":["Morden"],"firstnames":["Erna"],"suffixes":[]},{"propositions":[],"lastnames":["Timmerman"],"firstnames":["Venessa"],"suffixes":[]},{"propositions":[],"lastnames":["Britz"],"firstnames":["Stefan"],"suffixes":[]},{"propositions":[],"lastnames":["Mendelson"],"firstnames":["Marc"],"suffixes":[]},{"propositions":[],"lastnames":["Taljaard"],"firstnames":["Jantjie"],"suffixes":[]},{"propositions":[],"lastnames":["Riou"],"firstnames":["Julien"],"suffixes":[]},{"propositions":[],"lastnames":["Boulle"],"firstnames":["Andrew"],"suffixes":[]},{"propositions":[],"lastnames":["Tiffin"],"firstnames":["Nicki"],"suffixes":[]},{"propositions":[],"lastnames":["Zinyakatira"],"firstnames":["Nesbert"],"suffixes":[]}],"doi":"10.1101/2022.10.17.22281085","file":":C$\\$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Kassanjee et al. - 2022 - COVID-19 among adults living with HIV Correlates of mortality in a general population in a resource-limited se.pdf:pdf","isbn":"10.1101/2022.10.1","journal":"medRxiv","keywords":"OA,fund_ack,genomics_fund_ack,original","mendeley-tags":"OA,fund_ack,genomics_fund_ack,original","month":"oct","pages":"2022.10.17.22281085","publisher":"Cold Spring Harbor Laboratory Press","title":"COVID-19 among adults living with HIV: Correlates of mortality in a general population in a resource-limited setting","url":"https://www.medrxiv.org/content/10.1101/2022.10.17.22281085v1 https://www.medrxiv.org/content/10.1101/2022.10.17.22281085v1.abstract","year":"2022","bibtex":"@article{Kassanjee2022,\r\nabstract = {Introduction: While a large proportion of people with HIV (PWH) have experienced SARS-CoV-2 infections, there is uncertainty about the role of HIV disease severity on COVID-19 outcomes, especially in lower income settings. We studied the association between mortality and characteristics of HIV severity and management, and vaccination, among adult PWH. Methods: We analysed observational cohort data on all PWH aged ≥15 years experiencing a diagnosed SARS-CoV-2 infection (until March 2022), who accessed public sector healthcare in the Western Cape province of South Africa. Logistic regression was used to study the association of mortality with CD4 cell count, viral load, evidence of ART, time since first HIV evidence, and vaccination, adjusting for demographic characteristics, comorbidities, admission pressure, location and time period. Results: Mortality occurred in 5.7{\\%} (95{\\%} CI: 5.3,6.0) of 17 831 first diagnosed infections. Higher mortality was associated with lower recent CD4, no evidence of ART collection, high or unknown recent viral load (among those with ART evidence), and recent first HIV evidence, differentially by age. Vaccination was protective. The burden of comorbidities was high, and tuberculosis, chronic kidney disease, diabetes and hypertension were associated with higher mortality, more strongly in younger adults. Conclusions: Mortality was strongly associated with suboptimal HIV control, and prevalence of these risk factors increased in later COVID-19 waves. It remains a public health priority to ensure PWH are on suppressive ART and vaccinated, and manage any disruptions in care that occurred during the pandemic. The diagnosis and management of comorbidities, including for tuberculosis, should be optimised. {\\#}{\\#}{\\#} Competing Interest Statement The authors have declared no competing interest. {\\#}{\\#}{\\#} Funding Statement We acknowledge funding for the Western Cape Provincial Health Data Centre from the Western Cape Department of Health, the US National Institutes for Health (R01 HD080465, U01 AI069924), the Bill and Melinda Gates Foundation (1164272, 1191327), the United States Agency for International Development (72067418CA00023), the European Union (101045989) and the Grand Challenges ICODA pilot initiative delivered by Health Data Research UK and funded by the Bill {\\&} Melinda Gates and Minderoo Foundations (INV-017293). Funding was also received from Wellcome Trust (203135/Z/16/Z, 222574). The funders had no role in the study design, data collection, data analysis, data interpretation, or writing of this report. The opinions, findings and conclusions expressed in this manuscript reflect those of the authors alone. {\\#}{\\#}{\\#} Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Health Research Ethics committee of the University of Cape Town, and the Western Cape Government Provincial Department of Health, gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The data are not publicly available due to privacy or ethical restrictions. 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