In the largest case series to date of people living with HIV (PLWH) hospitalized with COVID-19 in the U.S., researchers reported in Clinical Infectious Diseases on May 30 that they saw no significant difference in prevalence or outcomes compared to HIV-negative people who have been admitted for the respiratory illness.
The case report involved 31 PLWH who were admitted to Columbia University Irving Medical Center and Allen Hospital in New York City between March 15 and April 15. Mean age was 61 years; 77% were male and 52% were Black, similar to the demographics of the overall population admitted to New York City hospitals for Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection.
PLWH accounted for 1.4% of the 2,159 people admitted to those hospitals for COVID-19 during the study period, slightly less than the 1.5% estimated HIV prevalence in the medical center’s catchment area.
In line with general population data on those most severely affected by the SARS-CoV-2, 71% of the PLWH cohort had at least one comorbidity, most commonly hypertension, diabetes mellitus, and/or obesity. None were taking lopinavir/ritonavir (Kaletra) as part of their antiretroviral regimen. (That drug had shown some activity against COVID-19 in vitro, but an in vivo trial had not found any mortality benefit in severe respiratory disease. The current study appears to confirm that result.)
COVID-19 outcomes were also similar to those in HIV-negative people, with eight people dying (all age 50 or older), 21 persons discharged, and two participants remaining hospitalized in intensive care as of the data censure date (May 12).
While the medical center usually sees PLWH whose virus is not well-controlled, 30 of the 31 patients were confirmed to be virally suppressed; no viral load data were available for one person.
This case report is one of roughly two dozen reports from around the world that have been published in medical journals since March. By and large, these reports—which to date include a total of nearly 250 people living with HIV who were hospitalized for COVID-19—support the theory that HIV (and HIV treatment) does not substantively affect a person’s risk for SARS-CoV-2 infection or the severity of their disease course.
Nonetheless, it is still possible that the lack of T-cell activation in poorly controlled HIV mitigates the immunopathology of COVID-19 and limits the cytokine storms characteristic of SARS-CoV-2-related immune dysregulation, study authors hypothesized. (As previously noted, their study almost entirely involved people with fully suppressed HIV, so they were unable to explore this question.) They called for more research into the interaction between intact cellular immunity and COVID-19 severity.