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Although the association between HIV and long COVID was inconclusive, the prevalence of long COVID in patients with HIV was high.
The prevalence of long COVID was high in patients living with HIV, according to a review published in eClinicalMedicine.1 Further research is needed to establish the association between HIV and long COVID in these patients.
The World Health Organization (WHO) has defined long COVID as experiencing symptoms of COVID-19 for at least 12 weeks after first contracting the virus without an alternative diagnosis. Shortness of breath, cognitive impairment, and fatigue are among the more common symptoms of long COVID. Approximately 39 million people live with HIV in the world, all of whom are more susceptible to long-term infection due to a weakened immune system.2 Although patients with HIV who are receiving antiretroviral therapy had reduced risk of poor outcomes of COVID-19, the effects of long COVID in patients with HIV remains understudied. This review aimed to collect data on prevalence of long COVID in patients living with HIV.
The researchers used EMBASE, MEDLINE, CINHAL, PubMed, and CENTRAL to search for studies to populate their review. All databases were searched from their inception through June 14, 2024. Studies that included adults living with HIV with a COVID-19 infection were included in the review. Adults who were not living with HIV were used as a comparator group. The prevalence of long COVID and the odds of long COVID in adults living with HIV acted as the primary outcomes.
There were 8 studies included in this review, of which 3 were from Europe, 2 were from North America, 2 were from Africa, and 1 was from Asia. The median (IQR) number of participants was 267 (94-383). The median age of the participants was 50 (45-51) years and the mean (SD) percentage of women included was 35% (23%) overall. Participants who were previously diagnosed with COVID-19 were included in most of the studies.
The prevalence estimates of the 8 studies were synthesized to estimate the prevalence of long COVID in adults living with HIV, with 6 studies using the 12-week cut off as defined by WHO and 2 studies using a 4-week cut off. The prevalence of long COVID in adults living with HIV was estimated to be 43% (95% CI, 32% to 54%). Sensitivity analysis found similar results with a high heterogeneity. When only using the studies that included the 12-week cut off, the prevalence remained consistent at 42% (95% CI, 27% to 58%).
The association between HIV and long COVID was only assessed in 4 of the included studies. This cohort of participants had a median age of 45 (41-49) years and had a mean percentage of women of 34% (25%). The 12-week cut off was used in all studies to define long COVID. The results of this analysis were inconclusive with an estimated OR of 1.16 (95% CI, 0.58-2.29) for the association between HIV and long COVID. When adjusting for confounding factors, the odds of an adult with HIV developing long COVID increased (OR, 2.21; 95% CI, 1.12-4.36). The certainty of evidence was rated low for both analyses.
There were some limitations to this review. The generalizability of the results may be limited due to the demographics of the included studies, as most of the participants were virally suppressed and were part of surveillance cohorts. CD4 counts in the included participants were also higher than the healthy cut off, which did not allow for evaluating patients with low CD4 counts and their association with poor health outcomes. Sex and gender were also hard to collect due to unclear definitions.
The researchers concluded that “prevalence of long COVID in adults living with HIV could be high (43%).” However, further research is needed to establish the relationship between HIV and long COVID as well as addressing long COVID in patients living with HIV.
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