Date of Award

2023

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Prof. Reena Shah

Second Supervisor/Advisor

Dr. Jasmit Shah

Department

AKU-East Africa

Abstract

Background: Since the first case of COVID-19, which was caused by the novel SARS-CoV-2 virus, was identified in Wuhan, China in December 2019, the infection has rapidly spread throughout the world. By March 2020, the World Health Organization declared COVID-19 to be a pandemic. On March 12, 2020, Kenya announced its first COVID-19 infection case. Since then, the number of cases has risen steadily, reaching 5190 cases and 144 fatalities (as of June 30, 2020), endangering the nation's healthcare system. In Kenya, where the prevalence of HIV is 4.9%, 1.38 million adults and 105,000 children are estimated to be HIV positive. Early findings from China suggested that those with weakened immune systems had a higher risk of developing significant COVID-19 illness. Nevertheless, little is known regarding the effect of HIV infection on the clinical outcomes of patients infected with COVID-19 outside of a few studies conducted in nations with a low HIV burden. Characterizing the risk of morbidity and death of HIV-positive patients from COVID-19 will require an in-depth study of the characteristics and outcomes of COVID-19 in HIV-positive patients.

Objective: This study's primary objective is to determine the prevalence of HIV among COVID-19 patients and to analyze their demographic and clinical data, including variables like CD4 viral load, anti[1]retroviral medication, and concomitant conditions like diabetes, hypertension, cardiovascular disease, and obesity. The outcome of COVID-19 in patients with HIV and HIV-negative patients will also be compared in the study.

Methods: A minimum sample size of 124 patients under the age of 18 who presented to the Aga Khan University Hospital in Nairobi with laboratory-confirmed COVID-19 infection on reverse transcriptase polymerase chain reaction (RT-PCR) from a nasal pharyngeal swab specimen and gave consent for an HIV test were included for this retrospective cohort study. iv Results: In our sample of 582 patients, the mean age was 49.2 years (SD=15.2) with 68% of the sample being males. The cumulative HIV prevalence was 3.7% and the most common symptoms were cough (58.1%), fever (45.2%), difficulty in breathing (36.8%), and general body malaise (23.9%). The most common comorbidities included hypertension (28.5%), diabetes mellitus (26.1%,) and heart disease (4.1%). Most participants 228 (49.5%) had mild COVID-19 and the mortality rate was 5%. Overall, there were no statistically significant differences in most demographic characteristics, clinical characteristics, and outcomes between HIV-positive and HIV-negative patients.

Conclusion: There was a 3.7 % prevalence of HIV in COVID-19-positive patients presenting to the Aga Khan University Hospital in Nairobi. Demographic, clinical characteristics and clinical outcomes were similar between the two groups. Future studies should work towards achieving larger samples, should include multiple study sites, and should conduct subgroup analysis based on the immunologic status of HIV-positive patients.

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