Physicians address ‘increasing concern’ about effects of COVID-19 among PLWH
In response to increasing concern about the ways in which infection with COVID-19 will affect people living with HIV, or PLWH, physicians from the University of Maryland, Baltimore and Arizona Liver Health have launched the Coronavirus Under Research Exclusion, or CURE, HIV-COVID registry for physicians to report cases of COVID-19 in PLWH. The goals of the registry are to understand the natural history of COVID-19 in PLWH, examine the impact of treatments that are given and share the findings with providers throughout the world to increase the medical community’s understanding of COVID-19.
“There is increasing concern that we don’t yet understand what specifically puts PLWH at risk for SARS-CoV-2 infection and the clinical outcomes of COVID-19 in these patients,” Infectious Disease News Chief Medical Editor Paul A. Volberding, MD, told Healio. “Many patients ask if they are considered to be at higher risk. In many cases, they are, as they are in the age groups that puts them at higher risk for worse outcomes due to COVID-19, even in the absence of their HIV status.”
The registry, which can be accessed here, allows providers from any region in the United States to upload data. Plans to make the registry available internationally are currently underway as well.
“Clinicians should closely monitor people with HIV who develop COVID-19 and have a low threshold for evaluation,” Rajesh T. Gandhi, MD, professor of medicine at Harvard Medical School and director of HIV Clinical Services and Education at Massachusetts General Hospital, told Healio. “Even though some antiretrovirals (like lopinavir/ritonavir) have been proposed to have an effect on the virus that causes COVID-19, so far the evidence does not support this proposition, and people with HIV should not change their antiretroviral regimen to prevent or treat COVID-19 unless they are in a clinical trial.”
Some clinicians are concerned about the lack of studies regarding the specific impact of COVID-19 in PLWH.
“People with well-controlled HIV have an excellent prognosis from an HIV standpoint. There's very little information right now concerning the effect of HIV on COVID-19,” Adaora Adimora, MD MPH, professor in the department of epidemiology at the University of North Carolina’s Gillings School of Global Public Health and Sarah Graham Kenan Distinguished Professor of Medicine in the UNC School of Medicine’s division of infectious diseases, told Healio. “One problem is that many people with HIV in the U.S. are aging and have a lot of related comorbidities, such as diabetes, hypertension, heart disease and chronic lung disease. These conditions increase the severity and mortality of COVID-19.”
According to the CDC, there are currently no specific data on the risk of COVID-19 in PLWH. However, older adults and people of any age with serious underlying medical conditions may be at a higher risk overall for severe illness; PLWH with a low CD4 cell count or who are not currently on HIV treatment are at the greatest risk.
Adimora noted that one’s living situation and occupation are also important factors to consider in regard the risk for COVID-19 in PLWH.
“We've already seen that there are substantial racial disparities related to COVID-19. This is probably in large part because of the disproportionate representation of African Americans in occupations that put them in harm's way for infection — for example, cashiers, factory workers and home health aides,” Adimora said. “Prisons are another huge problem, given the inadequate implementation of basic pandemic control measures, such as social distancing — and often inadequate health care in these settings. People with HIV, like other Americans, are especially vulnerable in these settings.”
The CDC encourages PLWH to continue their HIV treatment and follow the advice of their health care provider during the pandemic, as well as maintain a healthy lifestyle, including eating healthy, getting 8 hours of sleep and reducing stress.
Carlos del Rio, MD, FIDSA, executive associate dean at Emory University School of Medicine, told Healio that “spectrum of disease, the impact of antiretroviral therapy and the immune response” are areas of COVID-19 research in PLWH that are “worth investigating.”
“In PLWH who are virally suppressed and doing well, HIV should not change the spectrum of COVID-19 infection and should not be a reason to deny procedures like ICU care or intubation,” del Rio said.
Volberding emphasized the fact that sharing data on PLWH in ongoing COVID-19 trials will be essential as the pandemic continues.
“There are a large number of COVID-19 intervention trials launching around the world. It will be important to ensure that HIV-infected persons are not excluded, but rather that data on their HIV status be collected to enable outcome comparisons,” Volberding said. “This is obviously a very dynamic situation and bears our close attention and rapid data sharing.” – by Eamon Dreisbach
Disclosures: Adimora reports receiving research funds from Gilead, Merck and ViiV Healthcare and that Gilead provided her institution with funding for research. Gandhi reports serving on a scientific advisory board for Merck. Del Rio and Volberding report no relevant financial disclosures.
CDC. What to know about HIV and COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/hiv.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fspecific-groups%2Fhiv.html. Accessed April 21, 2020.