COVID-19 May Pose Greater Risk for People with HIV


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New research that finds people living with HIV may be at greater risk from COVID-19 than previously thought. Morsa Images/Getty Images
  • A new study suggests that people living with HIV may be more likely to contract, be hospitalized, and die from the new coronavirus, SARS-CoV-2, that causes COVID-19.
  • The study found that through the middle of 2020, people living with HIV in New York were 43 percent more likely to receive a diagnosis of COVID-19 than those without HIV.
  • They were also 161 percent more likely to be hospitalized.
  • People living with HIV who also received a COVID-19 diagnosis were 155 percent more likely to die in the hospital.

Now, nearly a full year into the COVID-19 pandemic, experts say everyone needs to continue to be vigilant to protect themselves and others from the disease through physical distancing and wearing protective masks.

This is especially true for people living with immune-compromising conditions like HIV.

New research examining New York state data through the middle of 2020 found that people who received a diagnosis of HIV were more likely to contract, be hospitalized with, and die from the new coronavirus, SARS-CoV-2, that causes COVID-19.

The study looked at data on 2,988 people living with HIV — 80.6 percent of whom were in New York City, which was the first major epicenter of the coronavirus outbreak in the United States.

The study was published in the journal JAMA Network Open.

The researchers combined New York databases for COVID-19 diagnoses and hospitalizations as well as HIV surveillance.

Then they compared rates for COVID-19 diagnoses, hospitalizations, and deaths between people living with HIV and those who weren’t from March to mid-June — the time period when COVID-19 was especially running rampant through the state, according to a press release.

The researchers said they conducted an “adjusted analysis” to determine how much of the elevated rates of serious COVID-19 cases were due to HIV itself.

This is due to the fact that people living with HIV have higher rates of COVID-19 risk factors, such as being male and older.

“I think we went into this under sort of expecting persons with HIV facing some sort of increased burden given that immune-compromising conditions are associated with secondary infections,” said study author Eli Rosenberg, PhD, associate professor of epidemiology and biostatistics at the University at Albany School of Public Health.

The study found that people living with HIV in New York were 43 percent more likely to receive a COVID-19 diagnosis than those without HIV. They were 161 percent more likely to be hospitalized.

People living with HIV who also received a COVID-19 diagnosis were 155 percent more likely to die in the hospital. From March to mid-June, 1 in every 522 people in New York living with HIV died in the hospital from COVID-19.

Rosenberg explained that these high rates are partly explained by looking at some overlapping risk factors for more serious HIV and COVID-19, but that “in terms of numbers of human beings lost, it’s very depressing.”

For people living with HIV reading about this study, there might be understandable confusion.

Some past research, like this study out of Mount Sinai over the summer, found COVID-19 outcomes were no worse for people living with HIV than without it.

When asked about these earlier reports, Rosenberg told Healthline that it’s important to understand that much of the past research on HIV and COVID-19 “came out of hospital-based studies.”

This is due to the fact that hospitals were the focus of much of the readily available early COVID-19 data.

This new study out of Albany is taking a “population-based view,” examining “everybody with HIV even before they get hospitalized” with COVID-19.

Rosenberg added this study is consistent with past research in it showed “fewer differences between those with and without HIV and COVID-19 once they are hospitalized,” but that the “hang-up is what is their likelihood of ending up in the hospital” to begin with.

“Those earlier looks were too late in the disease process” to present this kind of picture of whether HIV could potentially be a more significant risk factor for a more serious case of COVID-19.

Experts have long pointed out that people living with HIV do possess risks for serious COVID-19 given they have higher rates of comorbidities like high blood pressure, COPD, and smoking, among others.

This hasn’t suggested that HIV in and of itself automatically means you might be more likely to develop a more serious case of COVID-19.

It also depends on the state of someone’s overall health and immune system, which could make them more susceptible to more severe COVID-19.

When assessing and treating HIV, doctors measure people’s CD4, or T cell, counts. This refers to the white blood cells present in a person’s body needed to fight off infection.

People who have lower CD4 counts have more weakened immune function, according to the U.S. Department of Veteran Affairs.

Additionally, beyond the number of these immune-boosting white blood cells, doctors will monitor a person’s viral load, which essentially refers to the amount of HIV in the blood.

Advances in medical care and antiretroviral treatments can boost T cell counts to healthy levels as well as bring the viral load to an undetectable level, meaning people living with HIV are unable to transmit the virus to sexual partners.

Does having less-contained and well-treated HIV lead to more serious COVID-19?

Rosenberg said the data he and his team looked at doesn’t “comprehensively look at all the issues of a person’s HIV care.” The surveillance system they used doesn’t show an individual’s full medical record.

He added the study did find “a 30 percent increased risk of COVID-19 hospitalization for people with stage 2 HIV versus stage 1” and a “69 percent increased risk for stage 3 versus 1.”

Dr. Alan Taege, an infectious disease expert at Cleveland Clinic, told Healthline that it’s important to understand that large population-based studies like this one offer a “30,000-foot view looking at a massive population.”

It’s hard to zero in and make inferences about people based on such a broad look.

He said this paper didn’t look at specific comorbidities and cited that there are many factors — socioeconomic discrepancies, for instance — that can affect severity of both HIV and COVID-19.

When asked about the past looks at HIV and COVID-19, Taege said that he would like to “offer an asterisk” that HIV itself does have a degree of impact on a person’s health.

Taege, who wasn’t involved with this research, said the study does show a higher death rate for younger populations with higher CD4 counts, but that it doesn’t account for other risk factors.

Did those people also use injection drugs, for instance, or did they have other conditions like diabetes that could result in more serious COVID-19?

Rosenberg said that while this is the largest study of its kind of HIV and COVID-19 to date, a “big limitation” lies in the inability to delve into these other comorbidities that might “underlie both conditions.”

“Just because you can’t fully disentangle all of that doesn’t mean to discount the value of the information,” Rosenberg said. “Let’s say it were socioeconomic conditions that increased the risk of HIV and COVID-19 together. It still means HIV infection is an important marker of COVID.”

“It is a marker for a disenfranchised population or another at-risk group, and it’s an important factor for targeting and prevention and increasing social and health equity,” he added.

Taege said that he would encourage all people living with HIV — young and old — to be “extra vigilant with social distancing, mask wearing, handwashing, all the usual things.”

He would also strongly encourage them to get inoculated once the COVID-19 vaccine is available to them.

At the moment, people living with HIV aren’t officially designated by the Centers for Disease Control and Prevention (CDC) as a higher priority group than others to receive the vaccine in current rollout recommendations.

That could change down the line. For example, New York Gov. Andrew Cuomo recently included HIV in his list of comorbidities and underlying conditions for vaccine eligibility starting Feb. 15.

“Having my own bias, I would like my patients prioritized, but to put them ahead of people with organ transplants or cancer or advanced age may not be doing a service to the general population as much,” Taege added.

When it comes to the new study, Taege said it’s important that people “read the details carefully” to “understand what is missing.”

“It’s easy to jump to conclusions,” he cautioned.

For his part, Rosenberg said future research surrounding this data will investigate “the why” behind the numbers.

Specifically, he said it will be important to follow up on medical records and review them with state health data to understand the “deep role comorbidities might be playing.”

Rosenberg added that it will take time to perform that deeper medical analysis and delve into the information that wasn’t available in that initial state-wide surveillance data.



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