Preliminary results from a study of 12 987 COVID-19 patients in South Africa indicate that HIV and TB have a modest effect on COVID-19 mortality, scientists Quarraisha Abdool Karim and Salim Abdool Karim said.
According to the experts, 12% and 2% of COVID-19 deaths are attributable to HIV and TB, respectively, compared to 52% of COVID-19 deaths attributable to diabetes in South Africa.
"The small contribution of HIV and TB to COVID-19 mortality is mainly due to these deaths occurring in older people, in whom HIV and active TB are not common. Integrated medical care for these three conditions is important, as COVID-19 patients co-infected with HIV or TB start attending healthcare services in larger numbers," the scientists said.
Professor Salim Abdool Karim is the Director at the Centre for the AIDS Programme of Research in South Africa (CAPRISA) and the country's chief Coronavirus scientist. Professor Quarraisha Abdool Karim is an infectious diseases epidemiologist and Associate Scientific Director at CAPRISA.
The lead scientists published a paper in Science Magazine on how South Africa's TB and HIV infrastructure helped with a rapid response to COVID-19. However, they believe that the focus on COVID-19 has an "opportunity cost" to the enormous gains made against these conditions.
"We can't afford to be complacent," the scientists said.
Access to chronic medication
According to the pair, access to medical care for non-COVID-19 conditions was limited during the hard lockdown, with health facilities experiencing dwindling numbers of TB and HIV patients collecting their medication on schedule.
"In South Africa, 1 090 TB patients and 10 950 HIV patients in one province have not collected their medications on schedule since the start of the national lockdown."
Meanwhile, 13.2% of the 19 330 individuals surveyed in the country indicated that their medication for chronic disease was inaccessible during the lockdown.
"Furthermore, hospital admissions for HIV and TB declined as a result of hospitals reducing non-urgent admissions in preparation for a surge of COVID-19 cases and owing to closures to reduce exposure to COVID-19 patients," said the professors.
This could pose a threat and have substantial repercussions for both treatment and control, including the development of drug resistance for HIV and TB patients.
While the biological and epidemiological interaction of COVID-19, HIV and TB is not well understood, the two professors think that patients, whose immune system is compromised by HIV or TB, could be more susceptible to severe COVID-19.
South Africa's COVID-19 lockdown regulations have also had a disproportional impact on women, many of whom are self-employed or day labourers without a safety net, research revealed.
"This may have a longer-term effect on increasing diseases associated with poverty such as TB and with gender, such as HIV, for which young women bear a disproportionate burden," said the professors.
They also warned of the negative impact of the declining economy on HIV and TB programmes.
New and ongoing research
According to the professors, new and ongoing research on HIV and TB prevention and treatment have been affected by the pandemic.
South Africa has about 7.9 million people living with HIV and ranks among the worst-affected countries in the world for TB, with the fourth-highest rate of HIV-TB co-infection at 59%.
"At the initiation of the lockdown in South Africa, the National Health Research Ethics Committee suspended all medical research, including clinical trials.
"However, COVID-19 research efforts have increased collaboration and created new approaches to speed up therapeutic and vaccine development and testing, which will likely have long-term benefits for medical research beyond COVID-19," said the professors.
South Africa has made steady progress since 2010 in controlling both diseases. Access to antiretroviral drugs for treatment and prevention of mother-to-child transmission of HIV has resulted in a 33% reduction in AIDS-related deaths between 2010 and 2018, the professors said.
In addition, the death rate among TB cases has declined from 224 per 100 000 population in 2010 to 110 per 100 000 population in 2018.
"Past investments in infectious disease training and research have generated handsome returns to the COVID-19 response, highlighting the importance of maintaining these investments in the future," the professors said.
They said the resources built up over decades for the control of HIV and TB, and now redirected to control COVID-19, include diagnostic platforms, community outreach programmes, medical care access and research infrastructure.
However, the professors said the COVID-19 response also provides potential opportunities to enhance HIV and TB control.