Are People Living With HIV More Vulnerable to COVID-19?

May 3, 2021
Jaime Rosenberg

The jury is still out, but the evidence is accumulating that people with HIV with comorbidities such as diabetes may be at greater risk for hospitalization from COVID-19.

Over the past year, the COVID-19 pandemic has had lasting implications for healthcare for all Americans, but especially those with chronic conditions who may be more vulnerable to infection by the SARS-CoV-2 virus and suffer more serious when they do. A recent review published in Lancet, researchers took a look at the available data on the impact of COVID-19 on people living with HIV.

Although early reports indicated that people living with HIV were not at risk for more severe COVID-19 disease, as the pandemic continued, larger studies have started to show that might not be the case. And some recent research suggests that people living with HIV, particularly those with lower CD4 cell counts or untreated infection — typical indicators of worse outcomes for those living with HIV — fare worse if infected with COVID-19, according to lead author Juan Ambrosioni, Ph.D., of the University of Barcelona in Spain and his colleagues.

Their reviewed encompassed 11 studies that included a total of more than 4,000 study subjects. Three of the studies included in their review were conducted in the U.S. and a fourth was conducted in the U.S and Spain.

They point to results from a large New York-based study that showed that HIV put people at a higher risk of developing a severe case of COVID-19 requiring hospitalization, and the risk increased as the severity of the stage of HIV disease increased. However, in-hospital mortality was only affected by age, with patients who were 40 years or older being three to four times more likely to die.

Other research in the United States has suggested that different comorbidities, including diabetes and kidney failure, could increase the risk of hospitalization for COVID-19 among people living with HIV.

How HIV might affect the efficacy of the COVID-19 vaccines is unclear, wrote Ambrosioni and his colleagues. Few people with HIV were in the trials that led to the emergency use authorizations. But people living with HIV tend to have lower or delayed responses to several vaccines, including those that protecting people against the flu pneumococcal disease, and hepatitis B, according to Ambrosioni et al. and they said additional research is needed to determine if some vaccines are more protective than others for people living with HIV and whether booster shots will be needed for those living the disease.

Researchers have conducted studies of COVID-19 symptoms. By and large, the symptoms are the same for those with HIV and those without, although fever and cough may be more frequent in people living with HIV.

Despite these and other inklings of insights, the pandemic and its residual impacts are not fully understood, wrote Ambrosioni and his colleagues.

“Unfortunately, clearly establishing the interplay between the HIV/AIDS and COVID-19 pandemics will require a higher quality of evidence than is available,” wrote they wrote. “Emerging evidence seems to indicate a moderately increased risk of death and severity of COVID-19 in people living with HIV. Many aspects of COVID-19 and HIV/AIDS interaction need to be elucidated.”

Some treatment recommendations have been made even as research continues:

  • Treatment of COVID-19, including the use antivirals, should not differ from that of people without HIV.
  • Antiretroviral therapy (ART) should continue or be modified to promote activity against the virus.
  • Initial ART regimens with high barriers to resistance and low drug-drug interactions should be initiated, and changes in treatment regimen should be delayed unless necessary

In addition to direct effects, the pandemic has also created indirect challenges for people living with HIV because of the disruption of normal healthcare delivery. “When health-care systems are overwhelmed, deaths from manageable conditions, such as HIV, might increase substantially due to disruptions in essential health services,” wrote the researchers.