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Boswell MT, Maimela T, Hameiri-Bowen D, Riley G, Malan A, Steyn N, Nolutshungu N, de Villiers TR, de Beer Z, Mathabathe J, Tshabalala K, Abdullah F, Ramlall R, Heystek M, Basu D, Rheeder P, Ueckermann V, van Hougenhouck-Tulleken W. COVID-19 severity and in-hospital mortality in an area with high HIV prevalence. South Afr J HIV Med 2023; 24:1412. [PMID: 36751479 PMCID: PMC9900246 DOI: 10.4102/sajhivmed.v24i1.1412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 10/10/2022] [Indexed: 02/04/2023] Open
Abstract
Background HIV infection causes immune dysregulation affecting T-cell and monocyte function, which may alter coronavirus disease 2019 (COVID-19) pathophysiology. Objectives We investigated the associations among clinical phenotypes, laboratory biomarkers, and hospitalisation outcomes in a cohort of people hospitalised with COVID-19 in a high HIV prevalence area. Method We conducted a prospective observational cohort study in Tshwane, South Africa. Respiratory disease severity was quantified using the respiratory oxygenation score. Analysed biomarkers included inflammatory and coagulation biomarkers, CD4 T-cell counts, and HIV-1 viral loads (HIVVL). Results The analysis included 558 patients, of whom 21.7% died during admission. The mean age was 54 years. A total of 82 participants were HIV-positive. People living with HIV (PLWH) were younger (mean age 46 years) than HIV-negative people; most were on antiretroviral treatment with a suppressed HIVVL (72%) and the median CD4 count was 159 (interquartile range: 66-397) cells/µL. After adjusting for age, HIV was not associated with increased risk of mortality during hospitalisation (age-adjusted hazard ratio = 1.1, 95% confidence interval: 0.6-2.0). Inflammatory biomarker levels were similar in PLWH and HIV-negative patients. Detectable HIVVL was associated with less severe respiratory disease. In PLWH, mortality was associated with higher levels of inflammatory biomarkers. Opportunistic infections, and other risk factors for severe COVID-19, were common in PLWH who died. Conclusion PLWH were not at increased risk of mortality and those with detectable HIVVL had less severe respiratory disease than those with suppressed HIVVL. What this study adds This study advances our understanding of severe COVID-19 in PLWH.
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Affiliation(s)
- Michael T. Boswell
- Department of Internal Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Tshegofatso Maimela
- Clinical Public Health Unit, Department of Public Health Medicine, Steve Biko Academic Hospital, Pretoria, South Africa
| | - Dan Hameiri-Bowen
- Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - George Riley
- Department of Internal Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | | | - Nickietta Steyn
- Department of Internal Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Nomonde Nolutshungu
- Department of Medical Immunology, University of Pretoria, Pretoria, South Africa
| | | | | | - John Mathabathe
- Clinical Public Health Unit, Department of Public Health Medicine, Steve Biko Academic Hospital, Pretoria, South Africa
| | - Khanyisile Tshabalala
- Clinical Public Health Unit, Department of Public Health Medicine, Steve Biko Academic Hospital, Pretoria, South Africa
| | - Fareed Abdullah
- South African Medical Research Council, Pretoria, South Africa
| | | | | | - Debashis Basu
- Clinical Public Health Unit, Department of Public Health Medicine, Steve Biko Academic Hospital, Pretoria, South Africa
| | - Paul Rheeder
- Department of Internal Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Veronica Ueckermann
- Department of Internal Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
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Ogunleye OO, Basu D, Mueller D, Sneddon J, Seaton RA, Yinka-Ogunleye AF, Wamboga J, Miljković N, Mwita JC, Rwegerera GM, Massele A, Patrick O, Niba LL, Nsaikila M, Rashed WM, Hussein MA, Hegazy R, Amu AA, Boahen-Boaten BB, Matsebula Z, Gwebu P, Chirigo B, Mkhabela N, Dlamini T, Sithole S, Malaza S, Dlamini S, Afriyie D, Asare GA, Amponsah SK, Sefah I, Oluka M, Guantai AN, Opanga SA, Sarele TV, Mafisa RK, Chikowe I, Khuluza F, Kibuule D, Kalemeera F, Mubita M, Fadare J, Sibomana L, Ramokgopa GM, Whyte C, Maimela T, Hugo J, Meyer JC, Schellack N, Rampamba EM, Visser A, Alfadl A, Malik EM, Malande OO, Kalungia AC, Mwila C, Zaranyika T, Chaibva BV, Olaru ID, Masuka N, Wale J, Hwenda L, Kamoga R, Hill R, Barbui C, Bochenek T, Kurdi A, Campbell S, Martin AP, Phuong TNT, Thanh BN, Godman B. Response to the Novel Corona Virus (COVID-19) Pandemic Across Africa: Successes, Challenges, and Implications for the Future. Front Pharmacol 2020; 11:1205. [PMID: 33071775 PMCID: PMC7533592 DOI: 10.3389/fphar.2020.01205] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/23/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has already claimed considerable lives. There are major concerns in Africa due to existing high prevalence rates for both infectious and non-infectious diseases and limited resources in terms of personnel, beds and equipment. Alongside this, concerns that lockdown and other measures will have on prevention and management of other infectious diseases and non-communicable diseases (NCDs). NCDs are an increasing issue with rising morbidity and mortality rates. The World Health Organization (WHO) warns that a lack of nets and treatment could result in up to 18 million additional cases of malaria and up to 30,000 additional deaths in sub-Saharan Africa. OBJECTIVE Document current prevalence and mortality rates from COVID-19 alongside economic and other measures to reduce its spread and impact across Africa. In addition, suggested ways forward among all key stakeholder groups. OUR APPROACH Contextualise the findings from a wide range of publications including internet-based publications coupled with input from senior-level personnel. ONGOING ACTIVITIES Prevalence and mortality rates are currently lower in Africa than among several Western countries and the USA. This could be due to a number of factors including early instigation of lockdown and border closures, the younger age of the population, lack of robust reporting systems and as yet unidentified genetic and other factors. Innovation is accelerating to address concerns with available equipment. There are ongoing steps to address the level of misinformation and its consequences including fines. There are also ongoing initiatives across Africa to start addressing the unintended consequences of COVID-19 activities including lockdown measures and their impact on NCDs including the likely rise in mental health disorders, exacerbated by increasing stigma associated with COVID-19. Strategies include extending prescription lengths, telemedicine and encouraging vaccination. However, these need to be accelerated to prevent increased morbidity and mortality. CONCLUSION There are multiple activities across Africa to reduce the spread of COVID-19 and address misinformation, which can have catastrophic consequences, assisted by the WHO and others, which appear to be working in a number of countries. Research is ongoing to clarify the unintended consequences given ongoing concerns to guide future activities. Countries are learning from each other.
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Affiliation(s)
- Olayinka O. Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Lagos, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Debashis Basu
- Department of Public Health Medicine, Steve Biko Academic Hospital and the University of Pretoria, Pretoria, South Africa
- WHO Collaborating Centre for Social Determinants of Health and Health in all Policies, Pretoria, South Africa
| | - Debjani Mueller
- Charlotte Maxeke Medical Research Cluster, Johannesburg, South Africa
| | | | - R. Andrew Seaton
- Healthcare Improvement Scotland, Glasgow, United Kingdom
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
- University of Glasgow, Glasgow, United Kingdom
| | | | - Joshua Wamboga
- Uganda Alliance of Patients’ Organizations (UAPO), Kampala, Uganda
| | - Nenad Miljković
- Institute of Orthopaedic Surgery “Banjica”, University of Belgrade, Belgrade, Serbia
| | - Julius C. Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Godfrey Mutashambara Rwegerera
- Department of Internal Medicine, University of Botswana and Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Amos Massele
- Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Okwen Patrick
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon
- Faculty of Health and Medical Sciences, Adelaide University, Adelaide, SA, Australia
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon
- Department of Public Health, University of Bamenda, Bambili, Cameroon
| | | | | | | | - Rehab Hegazy
- Pharmacology Department, Medical Division, National Research Centre, Giza, Egypt
| | - Adefolarin A. Amu
- Pharmacy Department, Eswatini Medical Christian University, Mbabane, Eswatini
| | | | | | | | | | | | | | | | | | | | - Daniel Afriyie
- Pharmacy Department, Ghana Police Hospital, Accra, Ghana
| | - George Awuku Asare
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Seth Kwabena Amponsah
- Department of Medical Pharmacology, University of Ghana Medical School, Accra, Ghana
| | - Israel Sefah
- Ghana Health Service, Pharmacy Department, Keta Municipal Hospital, Keta-Dzelukope, Ghana
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Hohoe, Ghana
| | - Margaret Oluka
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Anastasia N. Guantai
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Sylvia A. Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Tebello Violet Sarele
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Westville-campus, Durban, South Africa
| | | | - Ibrahim Chikowe
- Pharmacy Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Felix Khuluza
- Pharmacy Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Mwangana Mubita
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University , Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Laurien Sibomana
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Gwendoline Malegwale Ramokgopa
- Department of Public Health Medicine, Steve Biko Academic Hospital and the University of Pretoria, Pretoria, South Africa
- WHO Collaborating Centre for Social Determinants of Health and Health in all Policies, Pretoria, South Africa
| | - Carmen Whyte
- Department of Public Health Medicine, Steve Biko Academic Hospital and the University of Pretoria, Pretoria, South Africa
- WHO Collaborating Centre for Social Determinants of Health and Health in all Policies, Pretoria, South Africa
| | - Tshegofatso Maimela
- Department of Public Health Medicine, Steve Biko Academic Hospital and the University of Pretoria, Pretoria, South Africa
- WHO Collaborating Centre for Social Determinants of Health and Health in all Policies, Pretoria, South Africa
| | - Johannes Hugo
- WHO Collaborating Centre for Social Determinants of Health and Health in all Policies, Pretoria, South Africa
- Department of Family Medicine, Steve Biko Academic Hospital and University of Pretoria, Pretoria, South Africa
| | - Johanna C. Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Natalie Schellack
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Enos M. Rampamba
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Pharmacy, Tshilidzini Hospital, Shayandima, South Africa
| | - Adel Visser
- Eugene Marais Hospital, Pretoria, South Africa
| | - Abubakr Alfadl
- National Medicines Board, Federal Ministry of Health, Khartoum, Sudan
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Elfatih M. Malik
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
- Community Medicine Council, SMSB, Khartoum, Sudan
| | - Oliver Ombeva Malande
- Department of Child Health and Paediatrics, Egerton University, Nakuru, Kenya
- East Africa Centre for Vaccines and Immunization (ECAVI), Kampala, Uganda
| | | | - Chiluba Mwila
- Department of Pharmacy, University of Zambia, Lusaka, Zambia
| | - Trust Zaranyika
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | | | - Ioana D. Olaru
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Nyasha Masuka
- Zimbabwe College of Public Health Physicians, Harare, Zimbabwe
| | - Janney Wale
- Independent Consumer Advocate, Brunswick, VIC, Australia
| | | | - Regina Kamoga
- Uganda Alliance of Patients’ Organizations (UAPO), Kampala, Uganda
- Community Health and Information Network (CHAIN), Kampala, Uganda
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, United Kingdom
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Tomasz Bochenek
- Department of Nutrition and Drug Research, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Antony P. Martin
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- HCD Economics, The Innovation Centre, Daresbury, United Kingdom
| | - Thuy Nguyen Thi Phuong
- Pharmaceutical Administration & PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Binh Nguyen Thanh
- Pharmaceutical Administration & PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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