In the early days of the pandemic, POZ published a summary of what HIV sufferers need to know about the new choronavirus. Many people with HIV were concerned about their risk because COVID-19-linked immune suppression is more stringent. In addition, nearly half of people living with HIV are over the age of 50 and many have underlying health conditions associated with worse COVID-19 outcomes.
At the time, small studies and reported reports suggested that people living with HIV were less likely to test positive for developing or dying from the new or severe COVID-19 coronavirus.
Indeed, there were some early suggestions that Truvada (tenofovir disoproxil fumarate / emtricitabine), used for the treatment or prevention of HIV, may provide some protection against the new virus, and that some antiretrovirals – especially Kaletra (lopinavir / ritonavir) —might be used for treatment. However, this has not been confirmed in controlled studies.
But as time went on, larger studies began to show that people with HIV and COVID-19 may in fact be at slightly greater risk for adverse outcomes.
James Tesoriero, PhD, of the New York State Department of Health and his colleagues recently reported in an introduction that people with HIV and COVID-19 had a higher hospitalization rate than people with HIV and COVID-19 .
Between March and June 2020, the researchers identified 2,988 cases of COVID-19 among people with HIV. After adjusting for age, gender and region, people with HIV were significantly less likely to be diagnosed with the coronavirus. People with HIV and COVID-19 had a 40% higher incidence of hospitalization, but once in hospital, mortality rates for people with and without HIV were similar.
In June, Mary-Ann Davies, MBChB, PhD, of the Western Cape Department of Health, and colleagues first reported on results from a study of COVID-19-diagnosed people in South Africa, with follow-up data presented at the International AIDS Conference. in July.
Among the 22,308 people with COVID-19, 625 died in total; old age and uncontrolled diabetes were the strongest risk factors for death. After adjusting for age and sex, the researchers estimated that people with HIV had a 2.4-fold higher probability of death due to COVID-19, and that about 8% of COVID-19 deaths could be being due to HIV.
Across studies, older HIV-positive people who had comorbidities had worse COVID-19 results, as is the case for the general population. Socioeconomic and racial / ethnic differences also apply to people with HIV and COVID-19, with blacks and Latino people more likely to get the coronavirus and develop severe disease.
People with HIV with poor control and low CD4 T-cell counts were found to be at increased risk for COVID-19 side effects. About one-third of people diagnosed with HIV in the United States do not get a viral infection. This reinforces the importance of initiating and continuing antiretroviral therapy despite restrictions imposed to reduce the spread of coronary artery disease.
Impact of COVID-19 on HIV Care
Early in the pandemic, people were advised to stay at home and reduce contact with the health care system. In many cases, telemedicine replaced personal visits. HIV testing, viral load testing and prophylaxis predisposition and pre-exposure (PrEP) have declined this year.
“People with HIV have gone into hiding, but we need to get them back to the clinics,” said Steven Deeks, MD, University of California at San Francisco (UCSF) in an interview for the July-August POZ feature on COVID- 19 and HIV. “We have to say that there is a balance between staying out of the health care system and being involved with the health care system. ”
In San Francisco, HIV testing dropped 54% in April, a month after the city enforced the shelter order, according to Hyman Scott, MD, of the San Francisco Department of Public Health ‘s HIV Bridge. Although tests have gone up since then, the number of tests in October was still 15% lower than last year. Viral load testing declined 57% in April, and in October it remained 20% lower than last year’s rate, Scott told POZ.
Monica Gandhi, MD, MPH, and colleagues at UCSF recently said that among people with HIV being cared for at the Ward 86 HIV clinic at San Francisco’s Zuckerberg General Hospital, the likelihood of viral transmission dropped 31 % compared to pre-COVID levels after clinic transfer to telephone visit. Telehealth ““ less access to clinic-based social support services may be necessary for viral prevention among vulnerable groups, ”the study authors wrote.
As COVID-19 cases and deaths continue to increase across the country, the arrival of the first vaccines means there is light at the end of the tunnel. Many people with HIV are wondering if the vaccines are safe for them and where they will be in the queue.
The first two vaccines authorized by the Food and Drug Administration, from Pfizer / BioNTech and Moderna / National Institutes of Health, were 95% and 94% effective in preventing symptomatic illness in Phase III trials.
Advocates successfully pushed for people with stable HIV to be included in the trials. Subgroup analyzes of these participants have not yet been presented, but unusual safety concerns have not been reported. However, people with immunocompromised adoptions may not respond as well as the vaccines.
“There is no reason to believe that people with HIV should not be vaccinated,” Gandhi told POZ. “I encourage my HIV-positive patients, especially those on antiretroviral treatment, to get vaccinated. I totally recommend it. ”
Now that vaccination is progressing well for health care workers and residents of long-term care facilities (Stage 1a), the debate continues on whether the next priority cycle should be give people aged 75 and over, who are more likely to die of COVID-19, or critical workers who are at risk of exposure. The Centers for Disease Control and Prevention (CDC) advisory committee included both groups in Phase 1b.
Level 1c includes people aged 65 to 74 and those under 65 with high-risk health illnesses that put them at higher risk for severe COVID-19. The CDC’s list of high-risk conditions includes cancer, kidney disease, obstructive pulmonary disease, Down syndrome, type 2 diabetes, heart disease, obesity, sickle cell disease, smoking and pregnancy . An immunocompromised state is introduced as a result of strong organ transplantation, but not HIV.
Proponents have argued that HIV-positive people should be considered a priority group. This is especially important for those with a visible viral burden, low CD4 count or AIDS-related illnesses. But even well-treated people with HIV who have an almost normal CD4 count may still have poor immunity and persistent inflammation that may raise their risk of COVID-19 complications.
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