People with well-controlled HIV do not have elevated COVID-19 risk — Wuhan study

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The first data from Wuhan, China suggest that people living with HIV suffered no worse a coronavirus epidemic than other people in the city, confirming the World Health Organisation’s position that people with well-controlled HIV do not appear to be at elevated risk of coronavirus infection or severe disease.

Nonetheless, Aidsmap reports, the risk of disruption to HIV services is significant, especially as the new coronavirus spreads to countries with fragile health systems. “We are bracing ourselves for an even larger pandemic in lower and middle-income countries,” Dr Meg Doherty, the new director of HIV programmes at the World Health Organisation (WHO) told a webinar organised by the International AIDS Society.

Doherty presented the WHO’s assessment of whether people with HIV are at increased risk from the new coronavirus. This is necessarily based on a very small evidence base and may need to be revised as the situation evolves.

The report says she noted that people with advanced HIV disease, a low CD4 count, a high viral load or who are not taking antiretroviral treatment are at increased risk from infectious diseases in general. WHO suggests that people in these circumstances should take additional precautions against the coronavirus.

But for people living with HIV who are clinically and immunologically stable on antiretroviral treatment, there is currently no evidence that their risk of infection or of complications is greater than for the general population. At the same time, many people living with HIV are in their sixties or seventies and have other co-morbidities such as diabetes or hypertension that are known to raise these risks.

The report says the most detailed report is from Wuhan, the Chinese city at the origin of the current outbreak.

Age was the only risk factor significantly associated with the development of COVID-19 (mean 57 years vs 36 years for those without disease). The researchers at Wuhan University and the Wuchang District Centre for Disease Control and Prevention do not report on additional health problems such as kidney or lung disease that patients may have had.

All of those with co-infection had an undetectable viral load (below 20) and most had CD4 counts above 350, reflecting the profile of the wider patient group. Of note, although 3% of all people with HIV in the cohort had a CD4 count below 100, none of them developed COVID-19.

In the webinar, Dr Olivier Nawej Tshikung of Geneva University Hospital in Switzerland said that of 985 people hospitalised for COVID-19 there, four people have had HIV co-infection. All had an undetectable viral load and a healthy CD4 cell percentage. However, their ages (55, 57, 66 and 79 years) and other medical issues (chronic obstructive pulmonary disease, hypertension and smoking) likely raised their risks. None of the approximately 800 other patients cared for by his hospital’s HIV clinic have sought help following the onset of COVID-19 symptoms.

Abstract
Background: There were over 49 thousand Coronavirus infected diseases-19(COVID-19) patients in Wuhan city, Hubei province, China, the center of epidemic of the disease. Over 5000 HIV/AIDS patients live in Wuhan. No data on the morbidity of COVID-19 in HIV/AIDS patients have been published to date.
Methods: In this study, we investigated 1178 HIV/AIDS patients in two central districts in Wuhan city. Whether they have any clinical presentations and whether they contacted any confirmed COVID-19 patients were inquired. The results for nucleic acid test (NAT) of SARS-CoV-2 and CT scan in those with clinical symptoms or contact history were investigated. The antiretroviral regimens of all these patients and other information, like age, sex, CD4+T cell counts (CD4 counts), HIV viral load (HIV-VL) were also collected. The risk factors for the COVID-19 in HIV/AIDS patients were analyzed.

Findings: We found 12 individuals in 1174 HIV/AIDS patients who presented clinical symptoms, and 8 of them were confirmed COVID-19. Six of them were NAT confirmed SARS-CoV-2 infection, and 2 were clinical confirmed cases. Six of the 8 COVID-19 patients had CD4 counts> 350/µl, and 2 with CD4 counts between 101-350/µl. All of the 8 patients have a low HIV-VL<20 copies/ml. The older age is the risk factor to occur COVID-19 in HIV/AIDS. All the 8 COVID-19 patients were from 947 individuals (0.84%) who took NRTI+NNRTI as antiretroviral regimen. In those who have no symptoms, there were another 9 HIV/AIDS patients had close contact with confirmed COVID-19 patients, and only 1 of them was confirmed positive by NAT.
Interpretation: Our findings indicated that the compromised immunity might be the reason that HIV/AIDS patients did not occur inflammatory changes and clinical symptoms, which support the early usage of corticosteroids in treatment for COVID-19. At the same time, the usage of LPV/r may potentially help to prevent or treat COVID-19.

Authors
Wei Guo, Fangzhao Ming, Yu Dong, Qian Zhang, Xiaoxia Zhang, Pingzheng Mo, Yong Feng, Ke Liang

Full Aidsmap report

The Lancet abstract

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