A point-prevalence study of body mass indices in HIV-positive and HIV-negative patients admitted to hospital with COVID-19 in South Africa

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A Parker
A G B Broadhurst
M S Moolla
L Amien
R Ahmed
J J Taljaard
G Meintjes
P Nyasulu
C F N Koegelenberg


Background. Obesity is now well recognised as a risk factor for severe COVID‐19, but the true prevalence of obesity in hospitalised adults with COVID‐19 remains unclear because formal body mass indices (BMIs) are not routinely measured on admission.

Objectives. To describe the true prevalence of obesity measured by the BMI, and associated comorbidities, in patients hospitalised with severe COVID‐19, including people with HIV (PWH).

Methods. We conducted a point‐prevalence study of measured BMI in consecutive patients with severe COVID‐19 admitted to the medical COVID‐19 wards in a tertiary academic hospital in Cape Town, South Africa (SA). Patients were enrolled over a 2‐week period during the peak of the first COVID‐19 wave in SA.

Results. We were able to measure the BMI in 122 of the 146 patients admitted during the study period. The prevalence of HIV was 20% (n=24/122). Most of the participants were overweight or obese (n=104; 85%), and 84 (68.9%) met criteria for obesity. The mean (standard deviation) BMI was 33 (7.5), and 34.5 (9.1) in PWH. Of PWH, 83% (n=20/24) were overweight or obese and 75% (n=18) met criteria for obesity. Multimorbidity was present in 22 (92%) of PWH.

Conclusion. We found that most patients, including PWH, met criteria for being overweight or obese. The high prevalence of obesity in PWH and severe COVID‐19 reinforces the need for targeted management of non‐communicable diseases, including obesity, in PWH.

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A point-prevalence study of body mass indices in HIV-positive and HIV-negative patients admitted to hospital with COVID-19 in South Africa. (2023). African Journal of Thoracic and Critical Care Medicine, 29(3), 127-130. https://doi.org/10.7196/AJTCCM.2023.v29i3.660
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How to Cite

A point-prevalence study of body mass indices in HIV-positive and HIV-negative patients admitted to hospital with COVID-19 in South Africa. (2023). African Journal of Thoracic and Critical Care Medicine, 29(3), 127-130. https://doi.org/10.7196/AJTCCM.2023.v29i3.660


Huang Y, Lu Y, Huang YM, et al. Obesity in patients with COVID‑19: A systematic review and meta-analysis. Metabolism 2020;113:154378. https://doi.org/10.1016/j.metabol.2020.154378

Parker A, Boloko L, Moolla MS, et al. Clinical features and outcomes of COVID‑19 admissions in a population with a high prevalence of HIV and tuberculosis: A multicentre cohort study. BMC Infect Dis 2022;22(1):559. https://doi.org/10.1186/


Centers for Disease Control and Prevention. Obesity, race/ethnicity, and COVID‑19. https://www.cdc.gov/obesity/data/obesity-and-covid-19.html (accessed 14 December 2022).

Parker A, Koegelenberg CFN, Moolla MS, et al. High HIV prevalence in an early cohort of hospital admissions with COVID‑19 in Cape Town, South Africa. S Afr Med J 2020;110(10):982-987. https://doi.org/10.7196/SAMJ.2020.v110i10.15067

Gao M, Piernas C, Astbury NM, et al. Associations between body-mass index and COVID‑19 severity in 6.9 million people in England: A prospective, community based, cohort study. Lancet Diabetes Endocrinol 2021;9(6):350-359. https://doi.


Joint United Nations Programme on HIV/AIDS (UNAIDS). Fact sheet 2023. Latest global and regional statistics on the status of the AIDS epidemic. https://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf (accessed 14

December 2022).

National Department of Health, South Africa, Statistics South Africa, South African Medical Research Council, ICF. South Africa Demographic and Health Survey 2016: Key indicators report. Pretoria: Stats SA, 2017. https://www.statssa.gov.za/publications/

Report%2003-00-09/Report%2003-00-092016.pdf (accessed 20 July 2020).

Western Cape Department of Health in collaboration with the National Institute for Communicable Diseases, South Africa. Risk factors for COVID‑19 death in a population cohort study from the Western Cape Province, South Africa. Clin Infect

Dis 2021;73(7):e2002-e2015. https://doi.org/10.1093/cid/ciaa1198

Bertagnolio S, Thwin SS, Silva R, et al. Clinical features of, and risk factors for, severe or fatal COVID‑19 among people living with HIV admitted to hospital: Analysis of data from the WHO Global Clinical Platform of COVID‑19. Lancet HIV

;9(7):e486-e495. https://doi.org/10.1016/S2352-3018(22)00097-2

Hadi YB, Naqvi SFZ, Kupec JT, Sarwari AR. Characteristics and outcomes of COVID‑19 in patients with HIV: A multicentre research network study. AIDS 2020;34(13):F3-F8. https://doi.org/10.1097/QAD.0000000000002666

Trickey A, Zhang L, Sabin CA, Sterne JAC. Life expectancy of people with HIV on long-term antiretroviral therapy in Europe and North America: A cohort study. Lancet Healthy Longev 2022;3:S2. https://doi.org/10.1016/s2666-7568(22)00063-0

Roomaney RA, van Wyk B, Pillay-van Wyk V. Aging with HIV: Increased risk of HIV comorbidities in older adults. Int J Environ Res Public Health 2022;19(4):2359. https://doi.org/10.3390/ijerph19042359

Mash RJ, Presence-Vollenhoven M, Adeniji A, et al. Evaluation of patient characteristics, management and outcomes for COVID‑19 at district hospitals in the Western Cape, South Africa: Descriptive observational study. BMJ Open

;11(1):e047016. https://doi.org/10.1136/bmjopen-2020-047016

Morgan OW, Bramley A, Fowlkes A, et al. Morbid obesity as a risk factor for hospitalisation and death due to 2009 pandemic influenza A(H1N1) disease. PLoS ONE 2010;5(3):e9694. https://doi.org/10.1371/journal.pone.0009694

Badawi A, Ryoo SG. Prevalence of comorbidities in the Middle East respiratory syndrome coronavirus (MERS-CoV): A systematic review and meta-analysis. Int J Infect Dis 2016;49:129-133. https://doi.org/10.1016/j.ijid.2016.06.015

Zulkipli MS, Dahlui M, Jamil N, et al. The association between obesity and dengue severity among pediatric patients: A systematic review and meta-analysis. PLoS Negl Trop Dis 2018;12(2):e0006263. https://doi.org/10.1371/journal.pntd.0006263

Tan VPK, Ngim CF, Lee EZ, et al. The association between obesity and dengue virus (DENV) infection in hospitalised patients. PLoS ONE 2018;13(7):e0200698. https://doi.org/10.1371/journal.pone.0200698

Saccon TD, Mousovich-Neto F, Ludwig RG, et al. SARS-CoV-2 infects adipose tissue in a fat depot- and viral lineage-dependent manner. Nat Commun 2022;13(1):5722. https://doi.org/10.1038/s41467-022-33218-8

Martínez-Colón GJ, Ratnasiri K, Chen H, et al. SARS-CoV-2 infection drives an inflammatory response in human adipose tissue through infection of adipocytes and macrophages. Sci Transl Med 2022;14(674):eabm9151. https://doi.org/10.1126/


Wolff JL, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med 2002;162(20):2269-2276. https://doi.org/10.1001/archinte.162.20.2269

De Francesco D, Sabin CA, Reiss P. Multimorbidity patterns in people with HIV. Curr Opin HIV AIDS 2020;15(2):110-117. https://doi.org/10.1097/COH.0000000000000595

Kim DJ, Westfall AO, Chamot E, et al. Multimorbidity patterns in HIV-infected patients: The role of obesity in chronic disease clustering. J Acquir Immune Defic Syndr 2012;61(5):600-605. https://doi.org/10.1097/QAI.0b013e31827303d5

Kumar S, Samaras K. The impact of weight gain during HIV treatment on risk of prediabetes, diabetes mellitus, cardiovascular disease, and mortality. Front Endocrinol (Lausanne) 2018;9:705. https://doi.org/10.3389/fendo.2018.00705

Alexopoulos A-S, Fayfman M, Zhao L, et al. Impact of obesity on hospital complications and mortality in hospitalized patients with hyperglycemia and diabetes. BMJ Open Diab Res Care 2016;4)1):e000200. https://doi.org/10.1136/bmjdrc-2016-000200

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