People living with HIV spent a similar amount of time in hospital as HIV-negative COVID-19 patients and had a comparable death rate during the height of the outbreak in New York City, but they were more likely to be put on ventilators, according to a study presented at the 23rd International AIDS Conference (AIDS 2020: Virtual).
A related study showed that people with HIV had higher levels of inflammation, indicating that they are capable of mounting a strong inflammatory response to the new coronavirus and remain at risk for severe COVID-19 despite taking antiretroviral therapy (ART).
Studies have generally found that people with HIV are no more likely to contract the coronavirus (known as SARS-CoV-2) than their HIV-negative counterparts, and they generally do not develop more severe illness or have a higher risk of death. An exception is a study from South Africa that did see increased COVID-19 mortality among HIV-positive people.
Given that people with HIV appear to have a similar risk of contracting SARS-CoV-2 and developing severe illness despite having some degree of immune suppression, some experts and advocates have suggested that antiretrovirals may have a protective effect. However, studies of the effects of HIV medications on COVID-19 outcomes have so far yielded mixed results.
Dr Viraj Patel of Albert Einstein College of Medicine and Montefiore Health System in the Bronx, New York conducted a retrospective cohort study of people with and without HIV who tested PCR positive for SARS-CoV-2 when they were hospitalised between 10 March and 11 May 2020. Montefiore is the largest provider of HIV care in the Bronx, serving more than 4000 people with HIV at four hospitals and 21 primary care clinics.
In a separate study, Dr John Hsi-en Ho of the Icahn School of Medicine at Mount Sinai in New York City looked at clinical and immunological characteristics among HIV-positive people with COVID-19.
HIV is characterised by chronic inflammation and varying degrees of immune dysfunction even in people on effective ART, Ho noted as background. COVID-19, too, is associated with abnormal immune function, including low lymphocyte levels.
This retrospective analysis included medical chart data from 93 people with HIV seen at five emergency departments in New York between 2 March and 15 April 2020 who tested PCR positive for SARS-CoV-2.
Abstract
We performed a retrospective study of Covid-19 in people with HIV (PWH). PWH with Covid-19 demonstrated severe lymphopenia and decreased CD4+ T cell counts. Levels of inflammatory markers, including C-reactive protein, fibrinogen, D-dimer, interleukin-6, interleukin-8, and TNF-alpha were commonly elevated. In all, 19/72 hospitalized individuals (26.4%) died and 53 (73.6%) recovered. PWH who died had higher levels of inflammatory markers and more severe lymphopenia than those who recovered. These findings suggest that PWH remain at risk for severe manifestations of Covid-19 despite ART and that those with increased markers of inflammation and immune dysregulation are at risk for worse outcomes.
Authors
Hsi-en Ho, Michael J Peluso, Colton Margus, Joao Pedro Matias Lopes, Chen He, Michael M Gaisa, Georgina Osorio, Judith A Aberg, Michael P Mullen
[link url="https://www.aidsmap.com/news/jul-2020/new-york-studies-look-covid-19-outcomes-and-immune-function-among-people-hiv"]Full Aidsmap report[/link]
[link url="http://www.natap.org/2020/IAC/IAC_67.htm"]AIDS 2020 (Virtual) abstract 1[/link]
[link url="https://academic.oup.com/jid/article/doi/10.1093/infdis/jiaa380/5864898"]The Journal of Infectious Diseases abstract[/link]