Individuals infected with HIV who were receiving regular follow-up treatment were not found to be protected from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and were not found to be at decreased risk for severe disease, according to a study recently published in the Lancet HIV.
Immunosuppression or regular use of antiretroviral therapy is believed to have the potential to modify the risk of developing COVID-19 and affect the clinical presentation of the infection in individuals infected with HIV. Furthermore, HIV-infected individuals may be at increased risk for infection or severe disease, especially if they have comorbidities, an unsuppressed HIV RNA viral load, or lower CD4 counts. However, data on incidence, clinical characteristics, and outcomes of HIV-infected individuals with COVID-19 are scarce. Therefore, an observational, prospective study was conducted to compare characteristics of HIV-infected individuals with COVID-19 to the general population.
In total, 51 of 2873 HIV-infected individuals aged ³18 years had suspected or confirmed COVID-19 and were included in the study (incidence of 1.8%). Confirmed COVID-19 was defined by positive real-time polymerase chain reaction (RT-PCR) testing for SARS-CoV-2 in respiratory samples, and suspected cases were defined as individuals with compatible clinical or radiologic findings who were diagnosed with COVID-19 but who did not undergo RT-PCR testing or whose results were inconclusive. The included individuals had a mean age of 53.3 years, the majority were men (84%), 69% had laboratory-confirmed COVID-19, and 55% required hospital admission.
Results of this study suggest that HIV-infected individuals are similarly affected by SARS-CoV-2 compared with the general population in terms of clinical, analytical, and radiologic presentation. Six (12%) individuals with COVID-19 were critically ill (2 of these individuals had CD4 cell counts <200 cells/µL), and 2 (4%) individuals died. A positive RT-PCR for SARS-CoV-2 after a median of 40 days from symptom onset was reported in 6 (32%) individuals, with 4 of these individuals having severe disease or low nadir CD4 cell counts. When compared with HIV-infected individuals without COVID-19, the 51 individuals with COVID-19 were of similar age and had similar CD4 cell counts. However, 32 (63%) individuals with COVID-19 had at least 1 comorbidity, while 495 (38%) of individuals without COVID-19 had at least 1 comorbidity (P =.00059). The most frequently reported comorbidities were hypertension and diabetes. When compared with HIV-infected individuals without COVID-19, more individuals with COVID-19 had received tenofovir (38% vs 73%, respectively; P =.0036) or had previous protease inhibitor use (mostly darunavir) (14% vs 22%, respectively; P =.578).
Overall, the data suggest that HIV-infected individuals should receive the same treatment as the general population. The study authors conclude that, “It is crucial that HIV-infected individuals are included in the investigational anti-COVID-19 strategies to gain insight into the best approach for this population.”
Vizcarra P, Pérez-Elías MJ, Quereda C, et al; on behalf of the COVID-19 ID Team. Description of COVID-19 in HIV-infected individuals: a single-centre, prospective cohort [published online May 28, 2020]. Lancet HIV. doi:10.1016/S2352-3018(20)30163-6