Table 2.
Characteristics of the included studies
| Study, country | Study design | Sample | Antiretroviral drugs | Findings and outcomes |
|---|---|---|---|---|
| Altuntas Aydin et al., 2020 [19] | Case series | 4 HIV patients with confirmed COVID‐19 | 3 of the 4 patients were on ART; all three patients received NRTI (tenofovir-based regimen/emtricitabine) and INSTI (dolutegravir/ elvitegravir) | - Use of regular antiretroviral drugs and suppression of viral load improved COVID-19 outcomes amongst HIV patients |
| Turkey | - Pre-existing comorbidities were an important factor in the mortality of COVID-19/HIV-coinfected patients | |||
| - 1 death occurred due to untreated comorbidities | ||||
| Blanco et al., 2020 [20] | Case series | Of 543 confirmed COVID-19 cases, 5 patients were HIV-positive | 4 patients were on ART; 2 patients received PI (darunavir-boosted cobicistat), and 2 patients received INSTI (dolutegravir) | - COVID-19/HIV-coinfected patients had similar symptoms of COVID-19 as the general population |
| Spain | - 4 patients were cured and 1 remained in the ICU at the end of the study | |||
| Childs et al., 2020 [21] | Case series | 18 COVID-19/HIV-coinfected patients | All 18 patients were on ART; all of them received NRTI, 11 received PI, 4 received NNRTI, and 3 received INSTI | - Hospitalized patients with COVID-19 were more likely to be of Black ethnicity and to have a lower CD4 cell count |
| United Kingdom | - 5 patients died, 12 patients recovered, and 1 patient remained in the hospital at the end of the study | |||
| Del Amo et al., 2020 [22] | Cohort study | 236 COVID-19/HIV-coinfected patients out of 77,590 HIV patients receiving ART | All COVID-19/HIV-coinfected patients received NRTIs; 21 received TDF/FTC (tenofovir disoproxil fumarate/emtricitabine, 100 received TAF/FTC (tenofovir alafenamide/ emtricitabine), and 57 received ABC/3TC | - 151 coinfected patients with COVID-19/HIV were hospitalized and 15 were admitted to the ICU |
| Spain | - The risk of diagnosis of COVID-19 was lower in HIV patients (30.0 per 10,000) than in the general population (41.7 per 10,000) | |||
| - This risk of diagnosis of COVID-19 was lower among HIV patients who received TDF/FTC | ||||
| - 20 patients died, of whom 10 were on TAF/FTC, 8 were on ABC/3TC, and none were on TDF/FTC | ||||
| Etienne et al., 2020 [23] | Cohort study | 54 COVID-19/HIV-coinfected patients | All 54 patients were on ART; 43 patients received NRTI, 33 received INSTI, and 25 received NNRTI | - COVID-19 severity in HIV patients was associated with male sex, older age, and metabolic disorders including diabetes mellitus and obesity |
| France | - 1 patient died | |||
| Gervasoni et al., 2020 [24] | Case series | Of 6,000 HIV patients, 47 had proven or probable COVID-19 infection | 80% of COVID-19/HIV-coinfected patients received INSTI, 11% received PI, and 42% received NRTI | - 13 COVID-19/HIV-coinfected patients were hospitalized |
| Italy | - The risk of severe disease, death, and admission to an ICU in COVID-19/HIV-coinfected patients compared favourably with that seen in the entire population of COVID-19 patients | |||
| - 2 deaths occurred | ||||
| Gudipati et al., 2020 [25] | Case series | 14 HIV patients had confirmed COVID-19 infection from 7,372 COVID-19 positive tests | 13 of the 14 coinfected patients received ART; 12 patients received tenofovir-based regimen (NRTI); one patient received a PI-based regimen | - 8 patients were hospitalized, and 2 patients were transferred to the ICU (both of whom have pre-existing comorbidities) |
| USA | - 1 patient died as a result of cardiac arrest | |||
| - Coinfected patients with COVID-19/HIV were not at a higher risk of death or severe outcomes than HIV-negative patients | ||||
| Guo et al., 2020 [10] | Cross-sectional study | 11 HIV/COVID-19-coinfected patients | 10 HIV patients with COVID-19 were on ART therapy; 9 patients received NRTI and NNRTIs, 1 patient received lopinavir/ritonavir (PI) | - The incidence rate of COVID-19 in HIV patients in Wuhan, China was comparable to that of the entire population (0.6%) |
| China | - Those who were of older age and treatment-naïve showed a marginal association with contracting COVID-19 | |||
| - 2 deaths | ||||
| Härter et al., 2020 [26] | Case series | 33 COIVID-19/HIV-coinfected patients | All patients were on ART; 31/33 received NRTIs, 20 received INSTI and 9 received NNRTI | - 91% of all COVID-19/HIV patients recovered and 76% were classified as mild cases |
| Germany | - 3/32 patients died (9.3%), of whom 1 patient was 82 yr old, the second patient had a CD4 cell count below 200/mm3, and the third patient suffered from several comorbidities | |||
| Hu et al., 2020 [27] | Case series | Of 2,900 HIV patients, 12 COVID-19/HIV-coinfected patients | 9 COVID-19/HIV patients received ART; all of them received NRTI and NNRTI | - Late initiation of ART among HIV patients could lead to more severe symptoms |
| China | - 1 patient died | |||
| Huang et al., 2020 [28] | Cohort study | 35 of 6,001 (0.6%) HIV patients had COVID-19 | 28/35 (80.0%) were on continued ART; 4 patients (11.4%) had discontinued their ART therapy; 32/35 (91.4%) received NRTI; 30/35 (80.5%) received NNRTI | - The incidence, case-fatality, and severity rates of COVID-19 in HIV patients were comparable to those in the entire population |
| China | - COVID-19 incidence amongst HIV patients on ART was lower than those who had discontinued therapy or were treatment-naive | |||
| - The COVID-19 incidence rate amongst HIV patients aged 50 yr or above was 3 times higher than amongst HIV patients younger than 50 yr | ||||
| - 2/35 deaths of patients coinfected with COVID-19/HIV in compared to 3,869/50,333 in the entire population | ||||
| Liu et al., 2020 [29] | Retrospective cohort study | 20 COVID-19/HIV-coinfected patients | 12 of 20 patients were on ART and 8 patients were treatment-naive; all 12 patients received NRTIs; 8 of them were on PIs, mainly lopinavir/ritonavir, and 6 were on NNRTI (efavirenz) | - Most COVID-19/HIV-coinfected patients (85%) presented with mild to moderate symptoms, which may be associated with ART history in HIV patients |
| China | - 1 death: an old man with pre-existing comorbidities | |||
| Meyerowitz et al., 2020 [30] | Cohort-based study | 36 patients living with HIV were diagnosed with COVID-19 | 35 patients were on ART; 29/35 received INSTI; 9 received NNRTI, 4 received PI, and 30 received NRTI | - 58% of COVID-19/HIV-coinfected patients including 8 severe and 7 critical cases required hospitalization |
| USA | - 30 patients (83.3%) had severe illness associated with pre-existing comorbidities | |||
| - 2 patients (5.6%) died | ||||
| Nagarakanti et al., 2021 [31] | Retrospective cohort study | 23 COVID-19/HIV-coinfected patients | 35% of patients received INSTI, 22% received NNRTI, and 26% received a combination of INSTI and PI | - Clinical outcomes were similar between COVID-19/HIV-coinfected patients and COVID-19 patients without HIV |
| USA | - 3 patients died | |||
| Sasset et al., 2020 [32] | Case series | 2 COVID-19/HIV-coinfected patients | Both patients received INSTI and PI | - Both patients suffered from several comorbidities |
| Italy | - 1 patient recovered and the second was still in the ICU at the end of this report | |||
| - Only 0.15% of the total HIV population showed COVID-19 symptoms | ||||
| SeyedAlinaghi et al., 2020 [33] | Cross-sectional study | Of 200 HIV patients, one patient had COVID-19 | The patient received lopinavir/ritonavir (PI) and Truvada (NRTI) | - Symptoms resolved in 1 wk |
| Iran | - HIV-positive patients and/or patients receiving ART may have a lower susceptibility to becoming infected with COVID-19 or have a decreased severity of the disease | |||
| Sigel et al., 2020 [34] | Cohort study | Of 439 COVID-19 patients, 88 were coinfected with HIV | All 88 coinfected patients were on ART; 85 patients received NRTI, 69 received INSTI, and 15 received PI | - During the follow-up period, most COVID-19/ HIV patients were discharged from the hospital |
| USA | - 18 patients died, most of whom had comorbidities such diabetes, hypertension, and chronic kidney disease | |||
| Stoeckle et al., 2020 [35] | Retrospective cohort study | 30 COVID-19/HIV-coinfected patients (case group) matched with 90 COVID-19 patients without HIV (control group) | 29/30 patients were on ART; 9 patients received PI (lopinavir/ritonavir) and 19 received NRTI | - Symptoms and laboratory findings were similar between cases and controls |
| USA | - Immunity suppression in HIV patients may result in less severe forms of COVID-19 and potentially favourable outcomes | |||
| - No deaths | ||||
| Swaminathan et al., 2021 [36] | Case series | 6 COVID-19/HIV-coinfected patients | 5/6 patients received ART; the majority of the patients were on INSTIs | - Some data suggests that the protective effect of antiretroviral drugs could result in a favourable outcome of COVID-19 in HIV patients |
| USA | - 2 deaths (both had multiple medical comorbidities) | |||
| Tian et al., 2021 [37] | Case report | 1 HIV/COVID-19-coinfected patient | The patient received lopinavir/ritonavir (PI) | - HIV patients who received regular antiretroviral drugs had no severe outcomes or a poor prognosis of COVID-19 |
| China | - No deaths | |||
| Vizcarra et al., 2020 [38] | Cohort study | 51 of 1,339 HIV patients were diagnosed with COVID-19 | 37 (73%) COVID-19/HIV-coinfected patients received NRTI and 41(80%) received INSTI | - Of all coinfected cases, 44 patients recovered |
| Spain | - Previous use of NRTIs or PIs was not associated with differences in the clinical presentation | |||
| - 2 deaths | ||||
| Yang et al., 2021 [39] | Case-control study | 3 COVID-19/HIV-coinfected patients (case group) | All coinfection patients received ART; 2 patients received NRTI and NNRTI; the third patient received NRTI INSTI, NNRTI | - The effects of antiretroviral drugs in the prevention and treatment of COVID-19 may be favourable, but seem to be limited |
| China | 53 COVID-19 patients without HIV (control group) | - No deaths |
COVID-19, coronavirus disease 2019; HIV, human immunodeficiency virus; ART, antiretroviral therapy; NRTI, nucleoside reverse transcriptase inhibitor; NNRTI, non-nucleoside reverse transcriptase inhibitor; PI, protease inhibitor; INSTI, integrase strand transfer inhibitor; ICU, intensive care unit; TDF, tenofovir disoproxil fumarate; FTC, emtricitabine; TAF, tenofovir alafenamide; ABC, abacavir; 3TC, lamivudine.