How Has the COVID-19 Pandemic Affected People With HIV?

A review of more than 200 studies found no greater risk of contracting COVID-19 among those with HIV but a greater chance of experiencing a severe case.

When the COVID-19 pandemic hit the United States in 2020, the healthcare community anticipated that people with HIV and other conditions that affected the immune system might be particularly vulnerable to the new respiratory illness.

So far, it looks like their worries were justified when it comes to people with HIV, at least with respect to the risk of experiencing a severe case of COVID-19,

“Although initial case studies and small cohorts found similar rates of infection and severity in PWH (people with HIV), the growing literature in diverse settings throughout the course of the pandemic now suggests that PWH are at greater risk for severe disease, even with well-controlled HIV,” Lauren K. Barbera, of the University of Colorado School of Medicine, and her colleagues said in a review article recently published in HIV Research and Clinical Practice.

In one study of over 3 million South African patients included in their analysis, the researchers found that having HIV was associated with a two-fold risk of COVID-19 death, regardless of CD4 count or HIV viral load. Other studies included in the analysis reported similar findings.

The review by Barbera and her colleagues included 212 articles published between March 2020 through July of this year.

The jury is still out, though, on whether people living with HIV are more likely to contract SARS-CoV-2, the virus that cause COVID-19, according to this sweeping review of the HIV-COVID-19 studies. People living with HIV, who account for 0.7% of the world’s adult population, account for approximately 0.5% to 1.5% of COVID-19 cases, they noted.

Here are some other findings about the interplay of HIV and COVID-19 revealed by the review:

  • No difference in presenting symptoms. The most common symptoms of COVID-19 are fever, shortness of breath and cough. Other symptoms include muscle aches, headaches and loss of smell or taste. The authors said study of 286 people with HIV found the presenting symptoms to the be the same and that other studies corroborated those findings.
  • Greater chance of a bad outcome.The review identified large studies as well as case reports suggest that people with HIV who become ill with COVID-19 are more likely to be admitted to the ICU than those without HIV. The mortality rate is also higher, multiple studies suggest. They cited a study in the United Kingdom that found a higher risk of death from COVID-10 among those with HIV, although the absolute number of deaths was relatively small.
  • Mental health consequences might be more severe. Barbara and her colleagues noted that social distancing and quarantining have left many people feeling isolated and experiencing loneliness.
    They said the effects may be “especially impactful” on people with HIV, pointing to results of a study showing that people with HIV have had increased worry about physical health, mental health, finances and accommodations during the pandemic. The researchers note that the uptake of telemedicine has aided in preventing restricted access to care amid the pandemic by offering flexibility and privacy benefits; however, the method of care also comes with barriers for people living with HIV, including low socioeconomic status, reimbursement issues, and digital literacy.