COVID-19 Clinical Presentation Among HIV-Infected Persons in China: A Systematic Review

Curr HIV/AIDS Rep. 2022 Jun;19(3):167-176. doi: 10.1007/s11904-022-00606-0. Epub 2022 Apr 8.


Purpose of review: The impact of HIV infection on the natural history of COVID-19 is unknown, given the recency of the human spread of SARS-CoV-2 (CoV). We reviewed published case series/reports of CoV-HIV coinfections to clarify epidemiologic and clinical features in China, the first nation with pandemic experience.

Recent findings: Assuming that HIV-infected persons were at average risk of CoV infection in Wuhan, we estimated HIV-CoV coinfected persons to number 412 (95%CI: 381-442); our review encompassed an estimated 16.7% (69/412) of Wuhan. Men (many of whom reported sex with other men) accounted for 71.1% (54/76) of the cases reported in China. The median age was 48.0 years old (range 24-77, interquartile:37-57). The median CD4+ cell count at the last clinical visit was 421 cells/μL; 83.0% had an undetectable viral load. Among 31 patients with clinical details reported, fatigue (41.9%), respiratory distress (41.9%), and gastrointestinal symptoms (26.7%) were most common. Among the 52 cases reporting COVID-19 clinical severity, 46.2% were severe, 44.2% mild, and 9.6% asymptomatic COVID-19. Late antiretroviral therapy (ART) was reported by 30.4% (7/23) among whom 57.1% (4/7) were confirmed as severe COVID-19. The case fatality rate was 9.1% (3/33). Severe disease and death were less common among persons who took ART prior to the COVID-19 diagnosis. Of 16 reported IL-6 results, 68.7% were within the normal range. Earlier use of ART was associated with a better COVID-19 prognosis with CoV-HIV co-infection reported from China through early 2021, but small sample sizes limit definitive conclusions.

Keywords: COVID-19; China; Clinical presentation; Coinfection; HIV; SARS-COV-2.

Publication types

  • Review
  • Systematic Review
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • COVID-19 Testing
  • COVID-19* / complications
  • COVID-19* / diagnosis
  • COVID-19* / epidemiology
  • China / epidemiology
  • HIV Infections* / complications
  • HIV Infections* / diagnosis
  • HIV Infections* / drug therapy
  • Humans
  • Male
  • Middle Aged
  • Pandemics
  • SARS-CoV-2
  • Young Adult