No association between use of tenofovir disoproxil fumarate, etravirine, or integrase-strand transfer inhibitors and acquisition or severe outcomes of SARS-CoV-2 infection in people with HIV in the Netherlands

Abstract

In two Dutch observational cohorts of people with HIV, the use of TDF, ETR, or INSTIs was not independently associated with either the risk of incident SARS-CoV-2 infection or severe COVID-19 outcomes, as was suggested by previous observational and molecular docking studies. Our findings do not support a strategy of modifying antiretroviral therapy to include these agents to protect against SARS-CoV-2 infection and severe COVID-19 outcomes.

Clearance of persistent SARS-CoV-2 associates with increased neutralizing antibodies in advanced HIV disease post-ART initiation

“…There have been a number of reports that TFV, a component of the ART regimen given to our study participants and possibly antiretrovirals inhibit SARS-CoV-2 infection [78][79][80] . Other studies did not observe an association between ART and SARS-CoV-2 clearance 81,82 . To investigate whether the TLD ART regimen used in the study could inhibit SARS-CoV-2, we tested the effect of TFV/3TC/ DTG co-formulated ART on SARS-CoV-2 and HIV infection in vitro (Supplementary Fig.…”

Preventing SARS-CoV-2 infection and its severe outcomes in HIV-infected people

“…However, a well designed study published in the current issue of the AIDS by Verburgh et al . [1] found no association between antiretroviral drugs and the acquisition or severe evolution of SARS-CoV-2 disease in HIV-infected people.…”

“…However, other studies have not confirmed these findings [16]. Furthermore, some studies, such as that by Verburgh et al [1], have ruled out any association between other antiretroviral drugs, such as etravirine (ETR) or integrase strand transfer inhibitors (INSTIs), and the acquisition or serious outcomes of SARS-CoV-2 infection.…”

Why Certain Repurposed Drugs Are Unlikely to Be Effective Antivirals to Treat SARS-CoV-2 Infections

“…In keeping with evidence-based medical practice, patients with COVID-19 must be treated with efficacious medications; they deserve nothing less”. Similarly, an editorial by Dr. Abrescia, concerning a study which showed a lack of association between antiretroviral use and the acquisition or severe outcomes of SARS-CoV-2 infection in people with HIV in the Netherlands, recommended the following: “If SARS-CoV-2 infection does take place, drugs proven to be effective against SARS-CoV-2 (remdesivir or nirmatrelvir/ritonavir) should be started within five days of the onset of symptoms” [ 207 , 208 ]. Our calculations of the unbound C max /EC 50 ratios and EC 50 measurements in the cell systems relevant to in vivo SARS-CoV-2 infection lends further support to that conclusion.…”