South Africa data shows higher COVID-19 death rates for people with HIV, TB

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A tuberculosis and HIV doctor at the Prince Cyril Zulu Clinic in South Africa. Photo by: CDC Global / CC BY

NAIROBI — Researchers have asked whether people living with HIV or tuberculosis might have a higher death rate from COVID-19 — given the impact these diseases have both on the immune system and the respiratory health of those infected.

On Tuesday, South Africa released the first set of data showing that there was an increase in COVID-19 deaths of people living with those diseases in Western Cape province — the country’s coronavirus hotspot.

Globally, other COVID-19 risk factors have been investigated showing that old age, people living with diabetes, especially those who are managing it poorly, as well as those with high blood pressure and chronic kidney disease have higher death rates from COVID-19.  

But this data hasn’t been available on TB and HIV, said Mary-Ann Davies, epidemiology and surveillance specialist at the Western Cape Department of Health, during a webinar.  

Tuberculosis can backslide to 2013 levels, new study reveals

The executive director of the Stop TB Partnership, Lucica Ditiu, says modeling can help national TB program managers quantify the seriousness of the issue and make people understand that "this is not a joke."

South Africa’s data found that people living with HIV had a 2.75 times increased risk of death, whereas those living with TB had a 2.5 times increased risk. It also found that HIV positive people on treatment, who are virally suppressed, and those who are not virally suppressed, both had an increased risk.

“This is not what we expected. We thought if there was any increased risk of death associated with HIV, that it would be driven by people not being on treatment and having poorer immune function. But it seems that whatever is going on is a little bit more complicated than that,” Davies said. “There’s clearly a whole lot of research that needs to be done to really understand this more fully.”

Although the data shows an increased risk for those with HIV or TB, it is still much smaller than other risk factors, including diabetes.

For example, in the Western Cape, 52 out of 100 people who have died from COVID-19 had diabetes, 19 out of 100 people who died had high blood pressure, while 12 out of 100 people who died had HIV, and 6 out of 100 people who died currently or previously had TB.

“What’s new from our data is that we’ve been able to quantify the effect of HIV and TB [on COVID-19], which until now we haven’t known and we might have expected that effect to really be large, but in fact what we are seeing is fairly modest,” Davies said.

While this data was based on patients seeking care in the public sector, the researchers extrapolated and estimated that for patients seeking care across the public and private sector about 8% of COVID-19 deaths are from people living with HIV.

Francois Venter, head of Ezintsha, says that this data are “revolutionary” and have “huge implications for how health programs and the COVID-19 response are handled.”

But the risk might be overstated if the researchers haven’t “fully disentangled” all of the risk factors from one another in the data, such as people living with both diabetes and HIV, people who are overweight, as well as those living in poverty, Davies said. Another important factor to consider is that people with HIV and TB tend to be younger and youth decreases overall risk of COVID-19 death, she said.

About the author

  • Sara Jerving

    Sara Jerving is a global health reporter based in Nairobi. Her work has appeared in The Wall Street Journal, The New York Times, the Los Angeles Times, Vice News, and Bloomberg News, among others. Sara holds a master's degree from Columbia University Graduate School of Journalism where she was a Lorana Sullivan fellow. She was a finalist for the Livingston Award for Young Journalists in 2018, part of a Vice News Tonight on HBO team that received an Emmy nomination in 2018 and received the Philip Greer Memorial Award from Columbia University Graduate School of Journalism in 2014. She has reported from over a dozen countries.