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COVID-19 Resource Center

Disclosures: Spinelli reports receiving funding from the NIH during the study. Please see the study for all other authors’ relevant financial disclosures.
May 09, 2021
2 min read

People with HIV had fewer — but more severe — SARS-CoV-2 infections than peers

Disclosures: Spinelli reports receiving funding from the NIH during the study. Please see the study for all other authors’ relevant financial disclosures.
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Researchers in San Francisco found that people with HIV had fewer SARS-CoV-2 infections but experienced more cases of severe COVID-19 than people without HIV.

Matthew A. Spinelli, MD, MAS, an assistant professor of medicine at the University of California, San Francisco, told Healio that a lower serological response among people with HIV may translate to lower protection from reinfection or shorter-lasting protection over time, although the study was not long enough to establish this with any certainty.

SARS-COV-2 seroprevalence
Source: Spinelli MA, et al. Lancet HIV. 2021;doi:10.1016/S2352-3018(21)00072-2.

In March, the NIH updated its interim guidance to say that people with HIV should be considered a high-risk group and be prioritized for COVID-19 vaccination. Past studies have shown that HIV increases the risk for death or poorer outcomes from COVID-19, whereas others have found it does not affect outcomes or the risk for hospitalization from the disease.

In the current study, Spinelli and colleagues said that people with HIV “probably had fewer SARS-CoV-2 infections as a result of greater caution and sheltering in place, which in turn was probably attributable to higher perceived susceptibility, experience of the HIV epidemic, or both.”

Matthew A. Spinelli

“Although the data are mixed, people with HIV, particularly those at lower CD4 counts, are likely at a somewhat higher risk of severe COVID-19,” Spinelli said. “Vaccination is an important step to protect from severe COVID-19.”

Spinelli and colleagues conducted a matched case-control observational study of people with HIV who underwent laboratory testing at San Francisco General Hospital. They collected 1,138 serum samples from 955 people with HIV and 1,118 samples from 1,062 people without HIV between Aug. 1 and Oct. 31, 2021.

The researchers then collected and age-matched the samples from people with HIV to randomly selected adults without HIV. They compared SARS-CoV-2 seroprevalence by HIV status and assessed severe COVID-19 in participants with previous SARS-CoV-2 infection.

They found that SARS-CoV-2 seroprevalence was 3.7% (95% CI, 2.4-5) among people with HIV and 7.4% (95% CI, 5.7-9.2) in the HIV-negative cohort (adjusted OR = 0.5; 95% CI, 0.3-0.83). In the 31 people with HIV and 70 HIV-negative participants who showed evidence of previous SARS-CoV-2 infection, the odds of severe COVID-19 were 5.52 (95% CI, 1.01-64.48) times higher in the HIV cohort.

When adjusted for time since PCR-confirmed infection, SARS-CoV-2 immunoglobulin concentrations were lower (–53% percentage change; 95% CI, –4 to –76) and pseudovirus antibody titers were lower (–67% percentage change; 95% CI, –25 to –86) among people with HIV compared with patients without HIV.

Spinelli said it will be important to recruit diverse people with HIV, including individuals who are not virologically suppressed or with low CD4 counts, which will offer “more intensive sampling” when studying T-cell responses.

“It will be very important to repeat this study following SARS-CoV-2 vaccination, as even in people with prior natural infection, vaccination could potentially boost antibody levels high enough that potential differences might not be clinically significant,” Spinelli said.