Covid-19-related in-hospital mortality in SA linked to high HIV and TB prevalence

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  • People infected with HIV and TB have an increased risk of dying from Covid-19.
  • Researchers used a national hospital surveillance system as a source of Covid-19 mortality data.
  • Age is still the strongest predictor of Covid-19 related deaths.


HIV and tuberculosis (TB) are linked to an increased risk of Covid-19 in-hospital mortality. 

The research published in The Lancet HIV investigated the factors associated with in-hospital mortality among patients with Covid-19 in South Africa using a national hospital surveillance system.

Assessing the cohort

The authors noted that South Africa has a national HIV prevalence of 19% among people aged 15–49 years and a tuberculosis prevalence of 0.7% in people of all ages. The study cohort included 13 793 people with HIV; 5 282 patients with tuberculosis; and 2 312 co-infected with SARS-CoV-2, HIV, and tuberculosis.

The researchers used a national hospital surveillance system for Covid-19 hospital admissions for patients admitted to hospital with laboratory-confirmed Covid-19 infection between 5 March 2020 and 27 March 2021.

The study considered comorbidities such as hypertension; diabetes; chronic cardiac disease; chronic pulmonary disease and asthma; chronic renal disease; malignancy in the past five years; HIV; and past and current tuberculosis as risk factors for Covid-19-related in-hospital deaths.

The researchers used a regression model to assess the role of HIV status and underlying comorbidities in Covid-19 in-hospital deaths.

The findings

The study results show that HIV and TB were associated with a moderately increased risk of Covid-19 in-hospital deaths, and a similar increased risk related to other underlying conditions such as diabetes, chronic renal disease, and malignancy during the past five years.

“People with HIV, particularly those with additional comorbidities, would benefit from Covid-19 prevention programmes such as vaccine prioritisation, as well as early referral and treatment programmes that include prioritising linkage and retention to HIV care, ART (antiretroviral therapy) adherence, virological suppression, and subsequent immune restoration,” the authors wrote.

The study found that people with HIV and are not on antiretroviral therapy were more likely to die in hospital than people with HIV on ART. Comorbidities were linked with increased Covid-19 in-hospital mortality risk in both HIV-positive and HIV-negative people.

The study also found that HIV prevalence among patients with Covid-19 varied. The Eastern Cape and Gauteng had a lower prevalence, while KwaZulu Natal and Mpumalanga had a higher prevalence.

The findings additionally show that age is the strongest predictor of Covid-19 in-hospital mortality in South Africa.

*For more Covid-19 research, science and news, click here. You can also sign up for our Daily Dose newsletter here.

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