人类免疫缺陷病毒/2019新型冠状病毒共感染不良预后影响因素的系统综述及荟萃分析

Systematic review and meta-analysis of influencing factors for poor prognosis of coronavirus disease 2019 in people living with human immunodeficiency virus

目的评价人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者患新型冠状病毒肺炎(COVID-19)后的相关临床特征与死亡相关性。方法文献检索2020年1月至8月发表的有关HIV和2019新型冠状病毒(2019 novel coronavirus,2019-nCoV)共感染的队列研究、横断面研究和病例系列,选择年龄、合并症、CD4^(+)T淋巴细胞计数、HIV RNA水平、抗反转录病毒方案为评价指标,使用系统综述及荟萃分析评估与病死率的关系。采用Stata 15.0软件进行荟萃分析。结果共纳入24篇文献,939例HIV/2019-nCoV共感染病例。总体病死率为10.3%(97/939),高龄及合并高血压、糖尿病、肾功能不全、慢性阻塞性肺疾病/哮喘、肿瘤与病死率增加相关(95%可信区间分别为0.005~0.050,0.042~2.294,0.390~2.754,0.513~2.848,0.348~3.743,1.943~7.101,P=0.021、0.043、0.012、0.008、0.022、0.005)。CD4^(+)T淋巴细胞计数<200/μL或>500/μL、HIV RNA水平低于检测下限及抗反转录病毒药物(包括替诺福韦)与病死率无相关性(均P>0.05)。结论HIV感染人群患COVID-19整体预后与普通人群相似,高龄及合并高血压、糖尿病、肾功能不全、慢性阻塞性肺疾病/哮喘、肿瘤与病死率增加相关,CD4^(+)T淋巴细胞计数与病死率无关,初步评估主流抗HIV药物对于COVID-19无明显保护作用。

Objective To investigate the clinical features and their relationship with mortality of coronavirus disease 2019(COVID-19)in people living with human immunodeficiency virus(HIV).Methods A thorough literature review was conducted about peer-reviewed publications including cohort study,cross-sectional research,and case series on HIV/2019 novel coronavirus(2019-nCoV)coinfection from January to August 2020.Systemic review and meta-analysis were used to investigate the correlation between mortality and clinical features including age,comorbidities,CD4^(+)T lymphocyte count,HIV RNA level,and anti-retroviral therapy.Stata 15.0 software was used for meta-analysis.Results Twenty-four articles were included with a total of 939 HIV/2019-nCoV coinfected patients.Overall mortality was 10.3%(97/939).Advanced age and comorbidities,including hypertension,diabetes mellitus,renal insufficiency,chronic obstructive pulmonary disease/asthma and tumor were all significantly associated with mortality(95%confidence interval 0.005-0.050,0.042-2.294,0.390-2.754,0.513-2.848,0.348-3.743 and 1.943-7.101,respectively,P=0.021,0.043,0.012,0.008,0.022 and 0.005,respectively).There were no correlations between mortality and CD4^(+)T lymphocyte count<200/μL or>500/μL,HIV RNA was below the lower limit of detection,or anti-retroviral drug(including tenofovir)(all P>0.05).Conclusions The overall prognosis of COVID-19 in people living with HIV is similar to general population.Increased mortality correlates with advanced age and comorbidities including hypertension,diabetes mellitus,renal insufficiency,chronic obstructive pulmonary disease/asthma and tumor.Low CD4^(+)T lymphocyte count does not affect mortality.Preliminary results indicate that anti-retroviral drugs have no protective effect on COVID-19.