Back to search

GLOBVAC-Global helse- og vaksin.forskn

SARS-CoV-2 infection in HIV-positive patients with or without antiretroviral therapy in sub-Saharan Africa

Alternative title: SARS-CoV-2-infeksjon hos HIV-positive pasienter med eller uten antiretroviral behandling i Afrika sør for Sahara

Awarded: NOK 0.45 mill.

**Translation to English:** The project "SARS-CoV-2 infection in HIV-positive patients with or without antiretroviral therapy in sub-Saharan Africa" has published an article describing the progress of the project. The article titled "COVID-19 and its effects on endothelium in HIV-positive patients in sub-Saharan Africa: Cardiometabolic risk, thrombosis and vascular function ENDOCOVID STUDY" provides a comprehensive overview of the project's background, goals, and approach. During the project period, data has been collected from Nigeria and South Africa. The datasets have different contents since South Africa has largely established a baseline for further research on over 200 participants. Various factors, including limited trust in the healthcare system in South Africa, made it challenging to follow up with patients. In Nigeria, fewer patients were included, but there were more straightforward follow-up opportunities. This will influence the results. An inception meeting was held in Mthatha, South Africa, in February 2020. Unfortunately, the start coincided with the lockdown of many countries, including South Africa, which complicated the data collection. Nonetheless, the inception meeting in South Africa initiated the project team, establishing the basis for collaboration, defining research questions, and planning data collection. During the data collection period, a status meeting was held in Graz, Austria, in June 2022. The meeting evaluated the project's progress, identified challenges, and adjusted strategies. Partnership was strengthened through the exchange of experiences and discussions. After the conclusion of data collection, a summary and discussion meeting was held in Oslo in October 2023. The results of the study were extensively discussed and assessed during the Oslo meeting, where the project team, along with relevant stakeholders, shared insights, challenges, and reflections. A concluding results and article meeting took place in Graz in November 2023. The project reached a significant milestone with a dedicated meeting to present and discuss concrete results and the way forward. The article meeting in Graz represented a critical phase in conveying the project's findings to the scientific community. **Conclusion:** The ENDOCOVID STUDY has pursued its overarching goal of evaluating SARS-CoV-2 infections in HIV-positive patients, assessing the severity of Covid-19, correlating with comorbidities, analyzing the effect of antiretroviral therapy, and evaluating Covid-19's impact on vascular function and coagulation. The study has collected data from Covid-19 patients in Mthatha, South Africa, and Lagos, Nigeria, over the past two years. The ongoing data collection, analysis work, and continuous quality assurance have been successful, even with the challenges posed by the pandemic. The partnership has proven robust throughout the project's various phases, and international collaboration has been crucial to the project's scope and success. The international article and meetings in Graz, Oslo, and Mthatha have served as a platform for knowledge sharing and conveying the significance of the project. The ENDOCOVID STUDY will continue to explore and analyze the data, prepare additional publications, and contribute to the global understanding of Covid-19's impact on individuals living with HIV. This report provides a glimpse into the work and challenges of the ENDOCOVID STUDY, emphasizing international collaboration.

The challenges encountered during data collection in South Africa included the difficulty in following up with patients after their discharge from the hospital, mainly due to their unwillingness to participate. Consequently, the available data was cross-sectional, collected only upon admission, and there was no post-discharge follow-up. Additionally, there was a limitation on the volume of blood that could be drawn, allowing only 10 ml due to the severity of the patients' conditions. This limitation resulted in some missing data, and exceptionally high values, likely due to measurement errors resulting from the limited blood volume, had to be deleted. Furthermore, some patients had pre-existing chronic conditions such as diabetes, hypertension, and neurological complications, which could have influenced the collected data. The medications these patients were on could also introduce errors into the dataset. The initial research application aimed to follow up with HIV-positive patients after their recovery from COVID-19. This proved to be a challenge due to most patients unwillingness to be followed up after hospital discharge, driven by a deep mistrust of the health system. Hospitals were often perceived as places where COVID-19 patients were sent to die, rather than to recover. Also, many patients lived in impoverished areas, posing safety risks for young female research assistants who were assigned to conduct the follow-up. The research team was unable to carry out the intended follow-up, and the study was limited to cross-sectional data. The research application also intended to compare patients with and without antiretroviral therapy (ART). In South Africa, all HIV-positive patients willing to participate in the study were on ART at the start of the study, rendering this comparison unfeasible. The analysis was therefore based on four groups: HIV-pos with COVID-19, HIV-neg with COVID-19, HIV-pos without COVID-19, and HIV-neg without COVID-19 (controls). The application included plans for retina scanning but due to patients' inability to open their eyes during their illness, this measurement was omitted. In Nigeria, only 33 patients were eligible for the study. Nevertheless, the research team was able to follow up with some patients (n=11) on one occasion. The dataset are eligable to produce a manuscript based on these data. Since the data collected in Nigeria differed significantly from that in South Africa, they were not merged but instead analyzed separately.

Background: Sub-Saharan African populations are increasingly facing a double burden of disease involving the interaction between HIV-AIDS and non-communicable diseases. The risk of severe disease with Covid-19 infections increases with age, male sex, and with co-morbidities such as chronic lung disease, cardiovascular disease, and diabetes. With Covid-19 infections, the risks increases further in these patients. Currently, there are no data about SARS-CoV-2 infection in people living with HIV. Aims: 1) To assess the percentage of SARS-CoV-2 infection in people living with HIV admitted in outpatient clinics in South Africa and Nigeria; 2) To assess how many people living with HIV proceed to Covid-19 and to estimate severity of Covid-19; 3) To correlate severity of Covid-19 and mortality risk in people living with HIV with comorbidities; 4) To assess the association of antiretroviral therapy on severity of Covid-19 in people living with HIV; and 5) To assess the effects of Covid-19 on vascular function and coagulation during infection and recovery. Methods: Three groups of participants will be included: 1) people living with HIV without antiretroviral therapy but with SARS-CoV-2 infection; 2) people living with HIV with antiretroviral therapy and SARS-CoV-2 infection; 3) HIV-negative patients, sex- and age matched, infected with SARS-CoV-2. Norwegian involvement: A post-doc (part-time) located at Kristiania University College, will support the planning of the study WP2) and the data analysis. Prof. Knut Lundin, UIO, will lead the data analysis and interpretation (WP6) part of the project. Prof. Fredriksen, Kristiania University College will lead the planning and execution phases of this project. The Norwegian team is specialized in public health assessment projects and data analysis. Impacts: This study provides an opportunity to study HIV-infected patients with or without antiretroviral terapi and HIV-negative controls co-infected with SARS-CoV-2.

Publications from Cristin

No publications found

No publications found

No publications found

No publications found

Funding scheme:

GLOBVAC-Global helse- og vaksin.forskn