Infectious disease expert Dr Dave Wessner explores what we know – and what we don’t know – about the impact of Covid-19 on HIV-positive people.

As the world grapples with the Covid-19 pandemic, it’s easy to forget that we’re also grappling with another global epidemic: AIDS. Since 1981, about 33 million people have died of AIDS-related illnesses, including about 700,000 in 2019. About 38 million people worldwide are currently infected with HIV, and in the United States about 36,000 new infections occur every year. Despite the availability of effective antiretroviral treatments, there is still no cure for HIV/AIDS. There is still no vaccine.

To fully understand the ramifications of Covid-19, public health researchers and clinicians are studying the impact of these two infectious diseases on each other. Specifically, the scientists are exploring three potential points of intersection; the risk of SARS-CoV-2 infection in people living with HIV, the severity of Covid-19 in people co-infected with coronavirus and HIV, and the potential impact of antiretroviral drugs on infections to coronavirus.

Are people living with HIV at higher risk of being infected with SARS-CoV-2?

Ultimately, probably not. It makes sense that people living with HIV are at greater risk of being infected with the novel coronavirus. After all, one of the hallmarks of HIV/AIDS is a reduced functioning of the immune system and an increased risk of opportunistic infections.

In a study recently published in The Lancet HIV, Spanish researchers began to address this hypothesis by comparing the rate of coronavirus infection in HIV-positive people regularly seen in their clinic with the rate of infection in the general community. At the time of their study, 1.8% (51/2,873) of HIV-positive people regularly attending their clinic had laboratory-confirmed or suspected cases of Covid-19. In the general population, this rate was about 4%. When only laboratory-confirmed cases of coronavirus infection were included, the infection rate was 1.2% in people living with HIV and 0.92% in the general population.

These results do not demonstrate an increased risk of SARS-CoV-2 infection in people living with HIV, but rather indicate that people living with HIV have a similar risk of contracting the Covid-19 virus as people living with HIV. seronegative.

What about the effects of coronavirus in people living with HIV?

It turns out that people living with HIV don’t seem to fare any worse than people without HIV, suggesting that the virus does not make Covid-19 worse. To answer this question, the researchers involved in the Spanish study also characterized the clinical manifestations of Covid-19 in people co-infected with SARS-CoV-2 and HIV and compared this to previous reports of manifestations of Covid-19 among the general population. For the most part, Covid-19 has presented similarly in people with and without an underlying HIV infection. In a similar study, Posted in Clinical infectious diseases, the researchers also explored the outcomes of Covid-19 in HIV-positive people. Again, people with HIV do not fare worse than people without an underlying HIV infection, suggesting that HIV does not exacerbate the effects of Covid-19.

Could some HIV/AIDS drug offers be used to treat or prevent Covid-19?

Maybe. Interesting way, a study published in the Annals of Internal Medicine showed fewer SARS-CoV-2 infections and fewer severe cases of Covid-19 in people with HIV who took a particular drug, Truvada, compared to HIV-positive people who took other drugs.

In this study, researchers evaluated more than 77,000 HIV-positive people. Of these, 236 have received a laboratory-confirmed diagnosis of SARS-CoV-2 infection. Although 16% of all people living with HIV were taking Truvada (TDF/FTC), only 9% (21/236) of HIV-positive people diagnosed with the novel coronavirus were taking this drug formulation. In other words, people taking TDF/FTC seemed less likely to be infected with the coronavirus. Similarly, HIV-positive people diagnosed with Covid-19 and taking TDF/FTC were less likely to be hospitalized than HIV-positive people with Covid-19 who were taking other antiretroviral therapies.

What do these studies tell us?

None of these studies show an increase in the rate of coronavirus infection or an increase in the severity of Covid-19 disease in people living with HIV. Indeed, the Annals of Internal Medicine The article provides some evidence that certain antiretroviral drugs may have a beneficial effect. However, it should be noted that all of these studies have limitations. They are small. They are observational and not experimental. They do not sufficiently take into account age differences or various comorbidities, factors that greatly influence the risks of Covid-19.

Nevertheless, it seems that people living with HIV who receive antiretroviral treatment do not generally have an increased risk of Covid-19. However, it should be noted that published studies looking at the confluence of Covid-19 and HIV/AIDS have taken place in Europe or North America. There is little information on the intersection of these two epidemics in Africa. Because sub-Saharan Africa bears a disproportionate burden of HIV/AIDS and is resource poor, the intersection of Covid-19 and HIV/AIDS in this region needs to be closely monitored.

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