Top 5 stories on COVID-19 and HIV from AIDS 2020 - aidsmap

The COVID-19 pandemic has changed many things about the way we live our lives. Researchers all over the world have been trying to find reliable information about this new virus. This was reflected in this year’s AIDS 2020 conference, which was held virtually to encourage social distancing. Many pieces of work were presented to answer some of the questions raised by coronavirus and its impact on people living with HIV. The following five articles highlight some of the key discoveries.

There has been much concern around whether having HIV makes a person more likely to catch or become seriously unwell from COVID-19. Researchers in the USA found that HIV does not increase the risk of catching or dying from COVID-19. Furthermore, taking HIV treatment did not seem to make a difference to COVID-19 outcomes, although this may be because patients with untreated HIV stayed home to protect themselves.

Similar conclusions were found in a study conducted in London, where COVID-19 patients living with HIV improved faster than patients that were HIV negative, when accounting for other illnesses and social class. Another London study also confirmed that black people living with HIV are more likely to require admission to hospital for COVID-19 than white people living with HIV.

Glossary

cytokines

Chemical "messengers" exchanged between immune cells that affect the function of the immune system. Interleukins such as IL-2 are a particular type of cytokine.

immune system

The body's mechanisms for fighting infections and eradicating dysfunctional cells.

diabetes

A group of diseases characterized by high levels of blood sugar (glucose). Type 1 diabetes occurs when the body fails to produce insulin, which is a hormone that regulates blood sugar. Type 2 diabetes occurs when the body either does not produce enough insulin or does not use insulin normally (insulin resistance). Common symptoms of diabetes include frequent urination, unusual thirst and extreme hunger. Some antiretroviral drugs may increase the risk of type 2 diabetes.

These studies directly contradict a South African study which found that HIV did increase the risk of death from COVID-19 and that risk was higher in those with uncontrolled HIV. The researchers found that the greatest risk factors for COVID-19 related deaths were diabetes and being older. However, the investigators stated that the increase in risk of death from COVID-19 in HIV-positive patients may be exaggerated if other illnesses were missed from their medical records.

Another important question is why coronavirus causes some people to become so unwell but not others. The severity of COVID-19 relates to dysfunction of the immune system, in which too many proteins known as cytokines are released, causing serious damage to the body. HIV targets the immune system, so researchers at Mount Sinai in New York wanted to find out whether this prevented the release of cytokines and thus provided some protection from severe disease. However, they found that HIV positive patients who died of coronavirus still produced large numbers of cytokines irrespective of CD4 count and HIV viral load, with higher cytokine levels than people who survived.

Will changes to healthcare caused by coronavirus have a negative impact on people living with HIV? Many African countries responded quickly to COVID-19 by implementing changes to medication distribution and follow up appointments. Some have decreased the number of clinic visits and now dispense more HIV treatment to last longer, known as multi-month prescribing. Data presented from a South Africa study showed that when people are given fewer clinic appointments, this does not lead to poorer HIV management.

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