COVID-19 Outcomes and Risk Factors Among People Living with HIV

Abstract

Purpose of Review In this review, we examine the intersection of the HIV and COVID-19 epidemics with focus on COVID-19-related health outcomes and risk factors for SARS-CoV-2 among people living with HIV (PLWH). Recent Findings Evidence to date do not suggest a higher incidence of SARS-CoV-2 infection among PLWH compared to the general population, although—once exposed—PLWH are at greater risk of severe COVID-19 outcomes. Key risk factors for severe COVID-19 include non-HIV comorbidities known to be associated with severe disease, as well as HIV-specific risk factors such as low CD4 + T-cell count, unsuppressed viral load, and tuberculosis co-infection. The disproportionate impact of the SARS-CoV-2 pandemic among Black, Latinx, and Native American/Alaskan Native PLWH could worsen pre-existing disparities in health outcomes among PLWH. Data on SARS-CoV-2 vaccine protection among PLWH needs additional study, although some studies suggest decreased humoral responses among those with low CD4 + T-cell counts, while there is a signal of increased vaccine breakthrough rates among PLWH in two large observational cohorts. Data on post-acute sequelae of SARS-CoV-2 (PASC) among PLWH is also limited. Summary PLWH do not have a higher susceptibility to SARS-CoV-2, but once exposed, they are at higher risk of severe COVID-19 outcomes. Additional resources will need to be dedicated to the development of interventions to improve health outcomes and address disparities among PLWH impacted by the COVID-19 pandemic.

Outcomes of coronavirus disease 2019-related hospitalization among people with HIV: historical cohort from the Greater Paris area multicenter hospital data warehouse

“…This study showed that risk factors of severe COVID-19 in PWH are non-HIV-related parameters, as previously reported in other countries [1,[4][5][6][7][8], although it is still controversial [4,5]. In the Italian cohort, the risk of poor COVID-19 outcome in PWH compared favorably with that observed in the HIV-negative COVID-19 patients of a similar mean age [6].…”

The Clinical Effectiveness and Safety of Vaccinations against COVID-19 in HIV-Positive Patients: Data from Observational Study in Poland

“…People living with HIV are a non-homogeneous group of immunocompromised persons, which includes both low CD4 count and ongoing immune activation impacting the response differently to and course of other viral infections [ 3 , 4 ]. Detectable viral load and concomitant chronic comorbidities independently increase the risk of severe outcomes of COVID-19 in this group of patients [ 5 , 6 , 7 , 8 ].…”

Barriers and facilitators related to COVID-19 vaccine acceptance and uptake among people living with HIV

“…These findings provide an important foundation for strategies working to increase vaccine uptake in the future. PLWH are at a higher risk of developing SARS-CoV-2 complications [56]. A robust public health response to address vaccine hesitancy in this population is critical.…”