Effect of Human Immunodeficiency Virus (HIV) Infection on Mortality Among Hospitalised COVID-19 Patients at Levy Mwanawasa University Teaching Hospital, Lusaka, Zambia

Round 1

Reviewer 1 Report

This article is one of the few that reported a statistical association between the HIV positivity and COVID-19 fatality. The study design, the data collection and analysis appears adequately performed. In addition, the study is ethically and statistically sound. However, this manuscript needs extensive English language proofreading.

 

 

Incorrect statement:

Line 67: "Clinically, COVID-19 presents with the following features include sign of pneumonia, hypertensive." So far, cohort studies have not shown that COVID-19 causes hypertension. Hypertension is not a hallmark symptom of COVID-19 (https://pubmed.ncbi.nlm.nih.gov/32442210/).

Incorrect statements or poor writing

The subsequent statements that I found to be incorrect are found in line 95, line 100, 135. This may be due to misspellings which adversely influence the interpretation/meaning of sentences. Unfortunately, the misspelling problem is widespread. As a consequence, the manuscript may require in-depth/extensive English language proofreading to accurately deliver the high quality data you have collected. 

Author Response

Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions/corrections highlighted/in track changes in the re-submitted files

Author Response File: Author Response.pdf

Reviewer 2 Report

Major comments

This article describes a study demonstrating that the COVID-19 survival rates in patients with and without HIV infection are different. The findings in this article are considered valuable, because various data have been published on whether or not SARS-CoV-2 infection can increase the mortality rate in HIV-infected individuals. In addition to the effect of HIV alone on mortality, a multivariate analysis showed an effect of HIV on COVID-19-related mortality, indicating that HIV countermeasures are extremely useful. Although this report describes a study conducted in Zambia, the findings can provide a useful warning for other countries where HIV is prevalent. I believe that the manuscript should be published.

 

However, the authors need to address the following issues before publication.

1.    The study has been completed, and the paper has sufficient analysis of factors that influence the mortality rate of COVID-19 patients.

However, it cannot be said that the analysis of HIV-infected patients is sufficient, and there is a lack of investigation into which aspects of HIV infection increase the mortality rate.

2.    Of particular concern is the lack of difference in mortality rates arising from SARS-CoV-2 infection depending on the presence or absence of ART. However, there is a large difference in the mortality rates arising from SARS-CoV-2 infection depending on the CD4 count. This is probably due to poor treatment adherence or differences in virus control. Success of ART may influence differences in mortality due to SARS-CoV-2 infection. Please provide any data that indicate poor treatment adherence. Also, if you have any examples of resistant viruses, please show them.

3.    Among the comorbidities of HIV infection, tuberculosis has an impact on mortality. In the authors’ study cohort, were there any differences in the distribution of tuberculosis patients between the non-survivor group and the survivor group?

Minor comments

1. Is there a significant difference between the two groups in Figure 1? If so, please indicate this difference (significance level p-value). Without such a difference, the conclusion in this paper is not possible.

2. The figure numbers should match the figure numbers in the text, and the table numbers should match the table numbers in the text.

3. Figures 3 and 4 are missing.

4. Please note that the provided submitted manuscript contains a number of errors, including spelling mistakes (such as ‘COVI-19’ at the start of the Introduction).

Author Response

Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions/corrections highlighted/in track changes in the re-submitted files.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

The authors have addressed my comments and improved the manuscript readability and quality

Minor comment

 Line 1706-1707 : There is a referencing error

Author Response

Thank you for pointing out this cardinal correction. The sentence as been revised and stated accordingly as median (interquartile range), thank you.