People with HIV face similar risk for COVID-19 as general population
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People with HIV do not have a higher or lower risk for severe COVID-19 than the general population and should receive a similar treatment approach, according to a study published in The Lancet HIV.
People living with HIV (PLWH) “should not be considered protected from SARS-CoV-2 infection or as having lower risk of severe disease,” Pilar Vizcarra, MD, of the department of infectious diseases at Ramón y Cajal University Hospital in Madrid, told Healio. “Particular attention should be paid to those with comorbidities or low CD4 cell counts who might have a higher rate of COVID-19 or worse outcomes.”
Vizcarra and colleagues performed an observational prospective study of 51 patients with HIV with suspected or confirmed COVID-19 who were admitted to a single hospital in Madrid. They compared clinical characteristics of patients with COVID-19 and HIV with those of 1,288 patients with HIV who did not have COVID-19 and were analyzed before the pandemic.
A total of 69% of coinfection cases were in patients with lab-confirmed COVID-19, 55% of whom required hospital admission. CD4 counts were similar in both groups, but 63% of patients with COVID-19 and HIV had at least one comorbidity compared with 38% of patients without COVID-19.
A total of 12% of patients were critically ill, two had CD4 counts below 200 cells per L and 4% died.
“Our results support the idea that PLWH have a similar COVID-19 infection rate as the general population,” Vizcarra noted. “Furthermore, clinical, laboratory and radiographical features were comparable to those reported in noninfected individuals. Therefore, PLWH should receive a similar treatment approach.”
Vizcarra emphasized the need for more research and noted several limitations of the study.
“Although we included all PLWH diagnosed with COVID-19 at the time of the analysis, we still reported a small number of patients, limiting the generalizability of the results,” she said. “Moreover, local recommendations restricted the use of confirmatory tests to people with admission criteria, which could have biased the rate of COVID-19 diagnosis. Further multicenter studies with seroprevalence data would elucidate our results.”
Perspective
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Paul A. Volberding, MD
In the early AIDS epidemic, we thought we were experiencing an amazing pace of scientific discovery, but all that pales in comparison to our new world of COVID-19. We — and of course our patients — are desperate to learn more to hopefully improve clinical care. Because many clinicians in COVID-19 care come to this from a background in HIV medicine, it’s natural to ask what the relationships are (if any) between these two viral infections. Very unfortunately, the explosion of coronavirus cases against a backdrop of many now living with chronic HIV infection allows us to start asking questions. Does HIV predispose individuals to SARS-CoV-2 infection? Is the clinical course different in the face of coinfection? Does antiretroviral therapy improve COVID-19 outcomes? Are those living with HIV and low CD4 cell counts at particular risk? Will coinfection limit SARS-CoV-2 antibody response? We are only just beginning to see the results of this quest for answers to these and other crucial questions.
In the recent Lancet HIV paper, a group from Spain report on the outcomes of COVID-19 disease in 51 persons living with HIV infection. It’s a single-site, descriptive cohort design, but the results are nevertheless interesting. We will see many larger reports soon, but the authors found that the two infections did not really lead to startling effects. The coinfected HIV group resembled those without COVID-19 in terms of age, CD4 cell count and HIV treatment history but did have a higher rate of comorbidities we have seen in SARS-CoV-2 monoinfection, compromising outcomes such as hypertension and diabetes. The author’s bottom line is either reassuring or not. HIV seems to neither increase nor decrease COVID-19 risk nor to decrease the likelihood of serious clinical outcomes. HIV coinfected persons should have similar treatments as those with only SARS-CoV-2. Expect to see more on these topics!
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