The Relationship Between HIV and COVID-19

Does having HIV make you more likely to experience severe illness from COVID-19? In this article Brigitte Tenni from the Nossal Institute for Global Health outlines the current research to help us better understand the relationship between HIV and COVID-19 infection.

What is HIV?

HIV is a virus that attacks CD4 cells that form part of the body’s immune system. Infection with HIV makes it difficult to fight infection and disease. HIV is transmitted in various ways – via anal or vaginal sex, using contaminated injecting equipment, via blood transfusion or from mother to child during pregnancy, birth, or breastfeeding. Currently, there is no cure for HIV, but it can be effectively managed with treatment.

Treatment for HIV is called anti-retroviral (ARV) therapy and is recommended for everyone who has HIV. ARV is a combination of medicines designed to reduce the amount of HIV in the blood to an undetectable level. An undetectable viral load means that the level of HIV in the blood is too low to be detected by a viral load test. Currently, over 37.9 million people worldwide are living with HIV with more than two thirds of those residing in Sub Saharan Africa.

Are people living with HIV at increased risk of severe disease from COVID-19? What does the latest research tell us?

Recent advice from several HIV NGOs is that people living with HIV who are currently taking ARV medication and have an undetectable viral load and no other significant health condition are at no greater risk of serious health consequences due to COVID-19 than the general population.

However, certain factors can make people living with HIV more susceptible to severe illness such as:

• Aged over 60 years old;
• Diabetic;
• Smoker;
• Have a comorbidity such as heart or lung issues;
• Detectable HIV viral load¹.

HIV and COVID-19

Given the relatively recent emergence of COVID-19, there is a dearth of research into the impact of COVID-19 infection on those living with HIV. As HIV impacts on immunity there was legitimate concern that people living with HIV would be more likely to become infected with COVID-19 and have greater mortality from COVID-19.

Some of the first pictures of COVID-19 clinical outcomes in people living with HIV came from the Infectious Diseases Service, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona² . They concluded that the symptoms and clinical course of COVID-19 in people living with HIV did not differ from those without HIV and that HIV does not place people at higher risk of severe illness from COVID-19.

This has also been the main finding of published case studies of people living with HIV who have contracted COVID-19 from China, Spain, Germany, Italy and the United States^3,4,5,6,7,8. Additionally, they found that there was no clear evidence of a higher COVID-19 infection rate in people living with HIV however most of the case studies noted a younger age in their study population than in HIV-negative hospitalised COVID-19 patients but comparable rates of comorbidities.

HIV and COVID-19 in Sub-Saharan Africa

The first report on COVID-19 risk in people living with HIV in sub-Saharan Africa was compiled by epidemiologists from the Western Cape Department of Health and includes data on COVID-19 from all public sector health facilities in the Western Cape province of South Africa. In contrast to the above studies, the researchers found that people with HIV were 2.75 times more likely to die from COVID-19 than HIV-negative people⁹. This is a concerning finding given the very high prevalence of HIV and the growing COVID-19 pandemic in this part of the world.

The researchers stressed that the impact of HIV on mortality was small compared with other known risk factors such as age and diabetes. There were some limitations to the report such as a lack of information on the patient’s socio-economic status, obesity or smoking, which may also be important risk factors.

The COVID-19 pandemic is evolving and spreading rapidly. Results of ongoing and future trials, especially in areas of high HIV prevalence, will be critical to providing a clearer picture of the relationship between HIV and COVID-19.

How can people living with HIV prevent infection with COVID- 19?

Like the rest of the population, people living with HIV should be vigilant about their health and follow existing national COVID- 19 guidelines to reduce the risk of acquiring COVID-19. In addition, it is advised people living with HIV:

• Maintain their ARV regime and have enough for at least 30 days, ideally longer;
• Ensure vaccinations are up to date (for example influenza and pneumococcal vaccines);
• Contact their health professional and have a plan in place if they feel unwell and need to remain at home;
• Eat nutritious food, exercise if they can, and take care of their mental health.