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Two men fill in a grave after the funeral of a man who died of COVID-19, at the Klip Road Cemetery in Grassy Park, Cape Town, on June 9, 2020.

RODGER BOSCH/AFP/Getty Images

People with HIV or tuberculosis have at least twice the risk of dying from COVID-19 – but the risks are even deadlier among people with diabetes or hypertension, a new report has found.

The report, based on South African data, is the first African review of how HIV and tuberculosis are affecting the coronavirus death rate, and one of the biggest such analyses anywhere in the world. Experts say it has huge implications for the estimated 48 million people worldwide who have HIV or TB.

The report is a setback for the hope that antiretroviral medicine for HIV would boost immune systems enough to protect people from the coronavirus. It found no significant difference in the death rate among HIV-positive people who were virally suppressed by taking the medicine and those who were not.

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But the review of almost 13,000 coronavirus cases has also provided some relief for those with HIV and TB, finding that the two diseases are less of a risk factor for dying from COVID-19 than some people had predicted.

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“We might have expected that this number would be much, much higher,” said Mary-Ann Davies, a public-health specialist in the government of Western Cape province, the epicentre of South Africa’s coronavirus cases.

“We were quite reassured that this number is not enormous, but nonetheless it is very important for us to remember that people with HIV and TB need to be included when we’re thinking of risk groups.”

South Africa has among the world’s highest rates of HIV and TB. Earlier reports have found that the coronavirus pandemic has greatly disrupted the diagnosis and treatment of the two diseases in recent months, sparking fears of a wave of deaths and illnesses over the next year.

The new report, examining coronavirus deaths in public hospitals in Western Cape, was presented by Prof. Davies on Tuesday at an event hosted by South Africa’s Bhekisisa Centre for Health Journalism.

It estimated that diabetes contributed to 52 per cent of coronavirus deaths, while high blood pressure was a factor in 19 per cent. It also estimated that HIV contributed to 12 per cent of deaths, and current or past TB was linked to 6 per cent.

Compared with other chronic health conditions, uncontrolled diabetes was the biggest risk factor for coronavirus deaths, the review found. Age, especially above 70, was the other major risk factor.

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Over all, people with HIV or TB had a two or three times higher risk of dying from the coronavirus, the report suggested. But it cautioned that it is difficult to disentangle the various risk factors that can combine to affect deaths, especially those such as obesity and poverty, where data is lacking.

François Venter, deputy executive director of the Wits Reproductive Health and HIV Institute at the University of the Witwatersrand in Johannesburg, said the review of the Western Cape risk factors was “revolutionary” and “absolutely critical” for understanding how to respond to the coronavirus pandemic in South Africa.

About two-thirds of South Africa’s 53,000 coronavirus cases have been recorded in Western Cape province.

The pandemic’s impact on HIV and TB has been a growing concern internationally. By disrupting the testing and treatment of the two diseases, the pandemic could cause 1.4 million additional TB deaths worldwide over a five-year period and 500,000 more deaths from AIDS-related illnesses in Africa over the next two years, according to recent studies.

Health authorities in South Africa have already found that thousands of people have failed to collect their HIV or TB medications since the beginning of the country’s lockdown restrictions in late March.

“That’s an absolute catastrophe,” Prof. Venter said on Tuesday. “There’s going to be a wave of sickness and death in the next six months, which is going to be as much of a problem as coronavirus for the health system.”

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