TB/HIV increases COVID-19 risk up to three-fold

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People with TB and HIV have a two to three-fold increased risk of dying of COVID-19, although this is still far less risky than for the elderly and people with diabetes, according to data released by Western Cape Health. News24 reports that the risk for people with these comorbidities is lower than what researchers expected.

As part of its analysis, the Western Cape reviewed 12 987 COVID-19 cases in its public sector, including 435 deaths. The department found that just over half of COVID-19 deaths were due to diabetes. In contrast, about one in 10 fatalities from the new coronavirus was due to being HIV positive and 2% were due to having active TB.

University of Cape Town associate professor Mary-Ann Davies, a public health specialist in at Western Cape Health, presented the findings during a webinar hosted by the Bhekisisa Centre for Health Journalism and the Aurum Institute where she highlighted that people living with HIV tend to be younger and the risk of developing serious COVID-19 illness for young people is very low. But she added that many deaths among people living with HIV occurred in those with other underlying health conditions, such as diabetes and high blood pressure.

News24 reports that the preliminary results, which Davies cautioned was not a formal study, also found virtually no difference in the risk of dying of COVID-19 between HIV-positive people who were virally suppressed and those who were not.

The Western Cape data set is not only the first in Africa, but likely one of the largest such analyses released globally on coronavirus and HIV as well as TB. "This is the first proper Africa data we have to start comparing ourselves to the rest of the world," says Francois Venter, deputy executive director at Wits Reproductive Health and HIV Institute. "It has huge implications for how we run our health programme and how we respond to COVID."

Although not being on HIV treatment may not put people at an extremely higher risk of serious COVID-19 than others, it does place them at an increased risk of developing other diseases such as TB, which remains the leading cause of natural death in South Africa, according to Statistics South Africa.


If you have uncontrolled diabetes, your chances of dying from COVID-19 are more than 13 times higher, the data revealed. While being in your 50s increases your chances of death tenfold, being in your 60s increased your chances more than 13 times, and being in your seventies, more than 19 times.

Yet, if you have HIV, it only increases your chances of dying by 2.75 times, and with TB it’s less than 2.6 times riskier (or only 1.4 times riskier for death if you’ve had it in the past rather than the present).

Davies in quoted in The Times as saying: “This is key information. We wanted to know in our population with its particular health profile who would be at highest risk of poor outcomes with COVID-19. We might have expected that effect of HIV and TB to be really large, but it is actually fairly low.”

Davies and the team collated information from 3.5m patients in the public health system in the Western Cape from the past three years and looked at associated factors.

The data, just as across the globe, showed that “men and people who are older are more likely to die from COVID-19 than others”. It was also known that comorbidities like diabetes (especially uncontrolled), high blood pressure and chronic kidney disease were also major risk factors for poor COVID-19 outcomes. But now, the new data has shown that people with TB are actually at a smaller increased risk of death than the other comorbidities.

The Times reports that according to Professor Gavin Churchyard of  The Aurum Institute, the data collated “is amazing and will help shape policy going forward”. He said many people could not access diagnostics and treatment for TB during lockdown, and it was therefore likely that undetected cases were spreading in communities. He described the response to COVID-19 as “both beneficial and harmful to the control of TB”.

While “social distancing and isolation” had helped prevent the transmission of TB, COVID-19 had also “interrupted diagnostics and treatment”. Ultimately, its “overall effect” had been harmful, he said.


According to the data compiled by the Western Cape government it was not just single illnesses to which COVID-19-infected succumbed: A full 65% of the patients cited had more than one comorbidity. And two out of five had three or more.

And, says a News24 report, it's not only patients taking the toll, but healthcare workers – a total of 6.3% of cases in the Western Cape. Provincial experts told President Cyril Ramaphosa on his visit last week that 1,662 healthcare workers had been infected so far. Of all patients hospitalised, 8.3% were healthcare workers. This South African figure was higher than China (3.8%), but lower than the US (11%), Spain (19%) and British Columbia, Canada (21%).

The report says Western Cape Health presented the president with a complex matrix, explained in its "Standard Operating Procedure for Hospital Staff Members with exposure to COVID-19 individuals". This calculated their potential exposure, and detailed the steps all staff had to follow, post-exposure. The province had also adopted a "Buddy Screening System", by which healthcare workers assessed peers.


Full News24 report




Full report in The Times


Full News24 report

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