Pharmacological considerations for the treatment of COVID-19 in people living with HIV (PLWH)

Abstract

Introduction When coronavirus infectious disease-2019 (COVID-19) blew up, ill-fated auguries on the collision between COVID-19 and the human immunodeficiency virus (HIV) epidemics loomed. Areas covered Data from observational studies suggest similar incidence attacks of SARS-CoV-2 infection in people living with HIV (PLWH) and HIV-uninfected populations. The mortality rate of COVID-19 is similar in both populations too. The authors discuss the role of combination antiretroviral therapy (cART) in preventing infection or reducing COVID-19 severity. They also discuss the pharmacological interventions for COVID-19 in PLWH. Expert opinion Management of COVID-19 in PLWH is no different from the general population. It should be based on careful supportive care, emphasizing lung-protective ventilation, and wise pharmacological interventions. The antiviral drug remdesivir and dexamethasone are the only pharmacological interventions with clinical benefit for COVID-19, whereas anticoagulation may prevent thrombotic complications. The experience with using these drugs in PLWH is limited, which prevents from rendering well-founded conclusions. Until more data on COVID-19 in PLWH become available, the best weapons within our reach are sound supportive care and sensible use of RDV and dexamethasone, bearing in mind the potential for drug–drug interactions of most corticosteroids and antiretroviral drugs.

HIV and COVID-19 Disease

“…Although dexamethasone, IL-6 inhibitors and JAK 1/2 inhibitors are recommended to treat COVID-19 pneumonia, within the HIV-infected population, there are no specific data for the use of such therapy. 111 126 127 128 129 130 Dexamethasone, ritonavir, and cobicistat are all metabolized by cytochrome P450 CA4, and whereas dexamethasone induces cytochrome P450 CA4 (CYP3A4) which can reduce ART levels, ritonavir and cobicistat are enzyme inhibitors which may increase the dose of corticosteroids with subsequent toxic effects 131 . Thus, ART drug levels should be monitored, not only with protease inhibitors and cobicistat but also with non-NRTIs, and only one dose of dexamethasone is recommended in combination with rilpivarine.…”

In Silico Identification and Validation of Organic Triazole Based Ligands as Potential Inhibitory Drug Compounds of SARS-CoV-2 Main Protease

“…NIPFC showed more than 36% antiviral activity against all tested viruses, with 60.61% antiviral activity against HIV (Supplementary Table S6). Based on antiviral prediction, it can be concluded that Bemcentinib, Bisoctriazole, and PYIITM can be used as potent antiviral drugs against the SARS-CoV-2 virus (Supplementary Table S5), because previous case and clinical studies suggested that some antiviral drugs mostly used for HIV showed effects against SARS-CoV-2 virus [31,32].…”

“…The SARS-CoV-2 virus belongs to the β category of human coronaviruses [1][2][3], and its genomic organization is similar to that of other coronaviruses [4]. The viral genomic RNA (27)(28)(29)(30)(31)(32) codes both structural and non-structural proteins. The structural proteins include membrane (M), envelope (E), nucleocapsid (N), hemagglutinin-esterase (HE), and spike (S) proteins.…”

In silico identification and validation of organic triazole based ligands as potential inhibitory drug compounds of SARS-CoV-2 main protease

“…NIPFC showed more than 36% antiviral activity against all tested viruses with 60.61% antiviral activity against HIV (Supplementary Table S5). Based on antiviral prediction, it can be concluded that Bemcentinib, Bisoctriazole and PYIITM can be used as potent antiviral drugs against the SARS-CoV-2 virus (Supplementary Table S5), because in previous case and clinical studies suggested that some antiviral drugs mostly used for the HIV showed effect against SARS-CoV-2 virus [28,29].…”

“…The SARS-CoV-2 virus belongs to the β category of human coronaviruses [1][2][3] and its genomic organization is like other coronaviruses [4]. The viral genomic RNA (27)(28)(29)(30)(31)(32) codes both structural and non-structural proteins. The structural proteins include: membrane (M), envelope (E), nucleocapsid (N), hemagglutinin-esterase (HE) and spike (S) proteins.…”