HIV infection, a risk factor for severe forms of Covid-19

Presented on the occasion of the launch of the IAS 2021 conference, a report from the World Health Organization indicates that HIV infection is an independent risk factor for serious illness from COVID-19.

WHO researchers analyzed clinical data submitted by 24 countries on more than 15,500 people living with HIV who have been hospitalized because of Covid-19. The mean age of these patients was 45.5 years. About 37% were men, 92% had received antiretroviral therapy and 36% of them suffered from a severe or critical form of Covid-19 upon admission. The other most common chronic diseases noted were hypertension, diabetes and obesity. Of those patients whose fate is known, 23% died in hospital.

In the hospitalized population monitored and compared to HIV-negative people, people living with HIV had an increased risk of severe or critical form of Covid-19 on admission to hospital (aOR 1.06, 95% CI 1 , 02 to 1.11), after adjustment for age, sex and the presence of other chronic diseases (diabetes, tuberculosis, malignant tumors and chronic heart and lung diseases). The risk of severe or critical illness assessed is the same, if the number of co-morbidities is taken into account in the modeling (aOR 1.13, 95% CI 1.09-1.17).

HIV-positive people, not a priority for vaccination

Based on previous studies, the evidence for the impact of HIV infection on the severity and mortality of COVID-19 was limited or even contradictory. Most of the studies have been conducted on relatively small cohorts, and in specific settings. Let us remember, however, that data from the OpenSAFELY study, presented at CROI 2021 at the start of the year, already showed that HIV-positive patients had a risk multiplied by 2.9 of death linked to Covid-19.

So far, people living with HIV are not among those considered particularly exposed to HIV, and are not given priority for vaccination. In France, learned societies and associations fighting against AIDS mobilized in January 2021 to ensure that people living with HIV access vaccination as soon as possible. All immunocompromised people are considered to be particularly exposed to SARS-CoV-2.

Missing data

While worrying, these results should nonetheless be greeted with moderation: The authors acknowledge that one of the major limitations of the data submitted to the WHO platform was the lack of information on the antiretroviral treatment of people. followed. In fact, as these data are only available in 40% of cases, we do not know the risks depending on the effectiveness of the HIV treatment. Likewise, weight and body mass index were not collected, even though being overweight is an important risk factor for severe forms of SARS-CoV-2 infection.

In any case, these results plead for increased access for people living with HIV to vaccination, in all countries: “This study underlines the importance of countries including all people living with HIV in the list of priority populations for national vaccination programs against COVID-19”said Adeeba Kamarulzaman, President of IAS and International Co-Chair of IAS 2021, at the launch press conference. “The global community must also do much more for access to Covid-19 vaccines in countries with high prevalence of HIV and other diseases. It is unacceptable that to date less than 3% of the entire African continent have received a single dose of the vaccine and less than 1.5% have received both doses. “

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