Preliminary results from a large study COVID-19 patients in South Africa indicate that HIV and TB have a modest effect on mortality, lead scientists Professor Quarraisha Abdool Karim and Professor Salim Abdool Karim, write in Science.
"Patients immuno-compromised by HIV or with TB lung disease could be more susceptible to severe COVID-19. However, preliminary results from a study of 12 987 COVID-19 patients in South Africa indicate that HIV and TB have a modest effect on COVID-19 mortality".
Professor Quarraisha Abdool Karim, associate scientific director of the Centre for the Aids Programme of Research in South Africa (CAPRISA) and Professor Salim Abdool Karim, a clinical infectious diseases epidemiologist at the University of KwaZulu-Natal.
They write that South Africa's drastic lockdown, "has had several unintended consequences for the provision of health care services for other prevalent conditions, in particular the prevention and treatment of tuberculosis (TB) and HIV. Key resources that had been extensively built up over decades for the control of HIV and TB are now being redirected to control COVID-19 in various countries in Africa, particularly South Africa.
"In Africa, the COVID-19 epidemic is unfolding against a backdrop of the longstanding TB and HIV epidemics. South Africa ranks among the worst-affected countries in the world for both diseases. Despite having just 0.7% of the world's population, South Africa is home to ∼20% (7.7 to 7.9 million people) of the global burden of HIV infection (2) and ranks among the worst affected countries in the world for TB, with the fourth highest rate of HIV-TB co-infection (59%)
"The restriction of people's movement and curtailment of public transport has led to substantial declines in patient attendance at health care facilities. In South Africa, 1,090 TB patients and 10,950 HIV patients in one province have not collected their medications on schedule since the start of the national lockdown. The World Health Organisation estimates that a six-month disruption of antiretroviral therapy could lead to more than 500 000 additional deaths from Aids-related illness in 2021 and a reversal of gains made in the prevention of mother-to-child transmission. The potential negative impact on the continuity of care for HIV and TB patients could have substantial repercussions for both treatment and control, including development of drug resistance.
"The biological and epidemiological interaction of COVID-19, HIV, and TB is not well understood. Patients immunocompromised by HIV or with TB lung disease could be more susceptible to severe COVID-19.
"However, preliminary results from a study of 12,987 COVID-19 patients in South Africa indicate that HIV and TB have a modest effect on COVID-19 mortality, with 12% and 2% of COVID-19 deaths attributable to HIV and TB, respectively, compared to 52% of COVID-19 deaths attributable to diabetes. The small contribution of HIV and TB to COVID-19 mortality is mainly due to these deaths occurring in older people, in whom HIV and active TB are not common.
"New and ongoing research on HIV and TB prevention and treatment have been severely affected by the COVID-19 epidemic. At the initiation of the lockdown in South Africa, the National Health Research Ethics Committee suspended all medical research, including clinical trials. Research progress on these two conditions has also slowed because several of the country's AIDS and TB researchers are redirecting their efforts to COVID-19.
"However, COVID-19 research efforts have increased collaboration and created new approaches to speed up therapeutic and vaccine development and testing, which will likely have long-term benefits for medical research beyond COVID-19. Several countries in Africa have well-developed HIV and TB clinical trial infrastructure that could contribute to COVID-19 vaccine trials.
"Past investments in infectious disease training and research have generated handsome returns to the COVID-19 response, highlighting the importance of maintaining these investments in the future."
Authors
Quarraisha Abdool Karim, Salim Abdool Karim
[link url="https://science.sciencemag.org/content/369/6502/366"]Science perspective[/link]