“HIV removes all the brakes on the immune system and as a result you get this robust and sustained inflammatory response – and now you have Covid on top of that,” said Dr. Steven Deeks, HIV expert at the University of California, San Francisco. “I would be surprised if HIV were not associated with the progression” of Covid-19.
Dr Deeks disagreed with the study researchers’ decision to adjust the stones for the presence of other conditions such as obesity, as HIV infection itself can cause good many of these diseases. “For 25 years, we have argued that a history of HIV infection is an independent risk factor for progression to heart disease, cancer, aging,” he said. Without this statistical adjustment, he said, the increased risk of death for these patients would likely have been higher than the 30 percent reported by the study.
Many previous studies had a bias that could have masked part of the risk: Doctors are more likely to admit patients with Covid-19 HIV to hospital, out of caution, leading to less sick patients and more likely to survive, compared to those without HIV According to Dr. Matthew Spinelli, infectious disease physician at San Francisco General Hospital.
“The early studies may have led people down the wrong path on this issue,” he said. The results of the new study are more in line with large population-based studies from South Africa and England showing that HIV infection doubles the risk of dying from Covid-19, and a similar study in New York State, he added.
The new findings should prompt doctors to provide people with HIV with rapid access to monoclonal antibodies or antiviral drugs to treat Covid-19, Dr Deeks said. The data also underscores the need to understand how HIV infection affects a person’s response to a Covid vaccine, and whether some people living with HIV need boosters as do many immunocompromised people.
AIDS activists have fought successfully for the inclusion of people with HIV in coronavirus vaccine clinical trials, but data is limited. A clinical trial in South Africa showed higher efficacy of the coronavirus vaccine made by Novavax when the analysis excluded people living with HIV, suggesting that HIV infection undermines the immune response to vaccines.
Of 100 countries that have released information, 40 have listed people living with HIV as a priority group for vaccination against Covid-19, said Dr Meg Doherty, who heads HIV programs at WHO .