Large UK study compares COVID-19 deaths in different populations with weakened immunity

The virus SARS-CoV-2 causes a disease called COVID-19. A pandemic caused by this virus began in 2020. Initially there was much fear about this virus because it was new, little was known about it and there were high rates of death among many hospitalized patients. Eventually vaccines were developed that greatly reduce the risk for serious illness, hospitalization and death.

Although SARS-CoV-2 continues to mutate, boosters have been developed and are regularly modified to keep pace with major mutations developed by the virus.

One main concern about SARS-CoV-2 was its impact on different populations, particularly people with weakened immune systems.

A team of researchers at Oxford University and the UK Health Security Agency scoured the scientific literature for studies published between 2020 and 2022. They focused on the risk of death in people diagnosed with COVID-19.

The review encompassed 99 studies with data from adults in the following populations:

• 1,542,097 people who had a weakened immune system
• 56,248,181 people who did not have a weakened immune system

Among immune-suppressed people, researchers focused on the following subpopulations:

• recipients of transplanted organs (specifically liver, kidney, lung and heart)
• people with cancer; subdivided into people with blood cancers and people with solid tumours
• HIV infection
• inflammatory diseases of the bone and joints
• inflammatory diseases of the skin (such as psoriasis)
• inflammatory diseases of the gut (such as Crohn’s disease and colitis)

Researchers divided people as follows:

• by age group
• by whether they lived in high-, medium- or low-income countries
• by whether they were hospitalized
• by the year that they were in a study (2020, 2021 and 2022)

Most of the studies reviewed came from high-income countries.

Results

People who received organ transplants or who had cancer (and whose cancers were untreated) were more likely to die from complications of COVID-19.

People whose cancers were being treated or people who had HIV or arthritis were less likely to die from COVID-19-related complications.

Note that researchers were not able to subdivide people with HIV by CD4+ cell count, use of HIV treatment (antiretroviral therapy; ART), type of ART used, viral load or underlying risk factors (such as heart disease, diabetes, high blood pressure, obesity and so on).

As with multiple other studies, researchers found that younger people were less likely to die than older people.

The overall findings from the present study are in broad alignment with several other major studies.

Bear in mind

The present study’s analysis should be seen as an overview. Every person has their own individual risk factors depending on their overall health. For people with HIV in particular, factors such as CD4+ cell count and viral suppression are important; however, these were missing from the study’s analysis. The study is useful as a crude tool for an overview of different populations. However, it cannot be used to derive individual health management strategies for people with HIV concerning their risk of dying from COVID-19.

The study did not assess whether populations had different intensities of COVID-19 or risks for long COVID. Other research teams are in the process of analyzing data from different sub-groups of people with HIV and their risk for COVID-19.

Note well

As mentioned earlier, for people with HIV, overall health, CD4+ cell count and viral load are all important factors to consider when discussing COVID-19-related issues with their healthcare provider.

A crucial step to better health for people with HIV is initiating ART and achieving and maintaining a suppressed viral load. It is important to discuss with healthcare providers possible causes of persistently detectable viral loads, if this is an issue.

A second step to better health is discussion of booster shots to reduce the risk of COVID-19-related complications (severe illness, hospitalization and death). The virus that causes COVID-19 is constantly mutating, so having regular booster shots on a schedule advised by a physician is important.

Discussion with a healthcare provider about steps to take to reduce possible exposure to SARS-CoV-2 is also important. Depending on one’s medical history and overall health, physicians may advise some patients to avoid crowded conditions and to wear a mask if this cannot be avoided.

In addition to regular boosters to reduce the risk for COVID-19, vaccinations against influenza, bacterial pneumonia and other respiratory conditions (such as respiratory syncytial virus, or RSV) can be useful.

—Sean R. Hosein

REFERENCE:

Leston M, Elson W, Ordóñez-Mena JM, et al. Disparities in COVID-19 mortality amongst the immunosuppressed: A systematic review and meta-analysis for enhanced disease surveillance. Journal of Infection. 2024 Jan 30;88(3):106110.