Estimating the global impact of coronavirus disease 2019 on people living with HIV

Abstract

Purpose of reviewThe COVID-19 pandemic and public health response have directly and indirectly affected broader health outcomes, especially for those with existing chronic conditions, including HIV. We examine our current understanding of the global impact of COVID-19 on people with HIV (PWH). Recent findingsThe interaction between COVID-19 and HIV is complex, making it challenging to estimate its true impact on PWH. Evidence to date does not suggest that HIV confers a higher risk of acquiring SARS-CoV-2. However, once acquired, HIV increases the risk of severe COVID-19 and mortality, particularly in immunosuppressed viraemic individuals and in the context of traditional COVID-19 risk factors, including disparities in social determinants of health. In addition, COVID-19 vaccines may be less effective in the context of HIV infection with additional doses needed. The consequences of disruption of access to essential prevention and treatment services because of the pandemic are becoming evident and will likely adversely affect outcomes, risking decades of progress. SummaryGiven the increased mortality risk and reduced vaccine effectiveness seen in PWH, specific prevention and support measures are needed, including prioritization of vaccination and boosters, funding to mitigate the impact of pandemic and enabling integrated healthcare delivery during pandemics will be critical.

Infezioni in Medicina

“…The impact of COVID-19 on services for PLWH is complex to estimate. The consequences of disrup-tion of access to treatment and care services has been evidenced in several reports and will likely adversely affect outcomes of HIV patients [6,7]. Particularly, access to ART is a critical public health priority during the COVID-19 pandemic.…”

“…The COVID-19 pandemic had a relevant impact on management of PLWH. Reduction to access to counselling and testing sites, reduced resources for PrEP, PEP and other prevention policies, and difficulties for ART delivery have been widely reported [6][7][8][9][10]. On the other hand, some strategies may be implemented in order to overcome the barriers due to COVID-19 for PLWH.…”

Clinical course and management of COVID-19 in the era of widespread population immunity

“…2) 18 . Persistent SARS-CoV-2 infection has been described in individuals with profound B-and T-cell immunodeficiencies, including hematologic malignancy and advanced HIV and those receiving immunosuppressing agents for other health conditions 19,20 . It thus remains an extremely challenging clinical entity whose ideal management is currently unknown [21][22][23] .…”

“…Receipt of other immunosuppressive drugs, in particular B-cell depleting agents like rituximab, are also associated with more severe outcomes, including after vaccination [51][52][53] . Finally, people living with HIV, particularly those with a lower CD4 + T-cell count, also have greater risks of severe illness and death that persist after vaccination 20,[54][55][56][57][58] .…”

Maternal immunization in women living with HIV

“…Maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with detrimental maternal, obstetrical and neonatal outcomes [5]. Patients living with HIV, specifically with low CD4 þ T-cell count or detectable viral load, have higher risk of poor COVID-19 outcomes [40]. Both primary maternal immunization schemes and booster doses with mRNA-based COVID-19 vaccines decrease the risk of severe maternal and neonatal diseases [16,41].…”