HIV and SARS-CoV-2 Co-Infection: What are the Risks?

Abstract

The dramatic increase of the global pandemic of SARS-CoV-2 infection represents a critical issue that needs to be investigated to evaluate the associated risk factors for acquisition and worse outcome. The interplay between immune activation and immune depression during SARS-CoV-2 infection is an intriguing topic that still needs to be clarified. The role of HIV in SARS-CoV-2 infection is not well defined. Chronic inflammation linked to HIV infection could be a driver for a worse prognosis in people living with HIV (PLWH). We explored the role of HIV as a risk factor for SARS-CoV-2 infection and severity and which factors contributed to a worse prognosis when HIV infection was present. PubMed/MEDLINE was searched for “COVID-19” or “SARS-CoV2” and “HIV” or “AIDS” and (“hospitalization” or “intensive care” or “mechanical ventilation” or “death” OR “mortality”), both in MeSH and as free text in all fields. Our review focused on 21 studies that enrolled at least 40 PLWH. In most studies, HIV infection did not represent a risk factor for SARS-CoV-2 infection. On the contrary, the risk of severe COVID-19 and hospitalization was higher in PLWH. Low CD4 cell count consistently emerged as a risk factor for severe COVID-19. Comorbidities, either in people with or without HIV diagnosis, played a key role, especially because of their early development in PLWH.

Post-acute COVID-19 syndrome: a new tsunami requiring a universal case definition

“…When compared to influenza, there are many differences in terms of clinical features, morbidity and mortality ( 2 ), and more so when considering the CFR (case fatality rate) of COVID-19 [0.1-25%] ( 3 ) with that of the more recent pandemic of influenza A H1N1 of 2009 [0.001-0.011%] ( 4 ). Patients with cancer and transplant recipients have an increased risk of worse outcomes, but no evidence on worse prognosis has been demonstrated in patients with primary immunodeficiencies and human immunodeficiency virus (HIV) infection ( 5 , 6 ). However, patients with systemic autoimmune diseases and high doses of corticosteroids or rituximab seem to be associated with more unfavourable outcomes ( 7 ).…”

Co-infection dynamics of COVID-19 and HIV/AIDS

“…For PLHIV, efforts such as vaccination minimize the chance of contracting COVID-19 disease, which might be one of the reasons for the relatively weak ability to produce antibodies and lower lymphocyte counts 47 . Treating co-infected individuals plays a vital role in reducing the number of deaths among HIV/AIDS patients.…”

“…HIV patients’ risk of transmitting the disease to another person or contracting another disease depends on their viral load. Following their compromised immunity, PLHIV may have an increased risk for severe disease from COVID-19 as well as hospitalizations 47 , 47 . This can be realized from Figs.…”

Characterization and determinant factors of critical illness and in-hospital mortality of COVID-19 patients: A retrospective cohort of 1,792 patients in Kenya

“…This implies that the co-infection rate of COVID-19 among people living with HIV is similar to the general population. Similarly, most studies reported no increase in the incidence of COVID-19 among people living with HIV compared to the general population [34] , [35] . The co-infection rate of COVID-19 patients with obesity, CVDs, diabetes, chronic liver disease, CLD, malignancy and renal disease was 1.5%, 6.2%, 5.4%, 2.0%, 2.8%, 1.8% and 1.5% correspondingly.…”