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HIV Infection Increases Risk of Severe COVID-19 Disease, Study Finds

A man enters the headquarters of the World Health Organization (WHO) in Geneva, Switzerland.

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Key Takeaways

  • An HIV infection increases the likelihood of severe illness and mortality from COVID-19, a study finds.
  • People living with HIV may have a relatively suppressed immune system in addition to other medical conditions, which increases their risk of severe COVID-19 disease.
  • It’s possible that people living with HIV have weaker immune responses to COVID-19 vaccines, but they should still be prioritized for vaccination, according to the WHO.

In a new study, researchers from the World Health Organization (WHO) suggested that an HIV infection increases the odds of COVID-19 mortality by 30%. Previous studies also found that an HIV infection is associated with more adverse COVID-19 outcomes and increased risk of mortality.

Much remains to be known about the effect of having COVID-19 and HIV simultaneously, but these findings emphasize how important it is for immunocompromised individuals to take all available safety precautions during this pandemic.

Earlier in the pandemic, smaller studies also suggested that an HIV infection has no impact on hospitalized COVID-19 patients.

Jaimie Meyer, MD, Yale Medicine infectious diseases specialist and associate professor at the Yale School of Medicine and Yale School of Public Health, tells Verywell Health that most of these studies do not clearly explain why people living with HIV have significantly a higher risk of severe COVID-19 disease.

One possible explanation could be people living with HIV have a relatively suppressed immune system, making it difficult to combat the COVID-19 virus, Meyer says.

“Another possibility is that people living with HIV experience a number of other health conditions—like high blood pressure, diabetes, obesity, tuberculosis, chronic lung and liver disease, etc.—that poses additional risks for severe COVID-19 disease," she says.

HIV

Human immunodeficiency virus (HIV) is a virus that attacks the body's immune system by destroying cells that help the body fight disease and infection. If left untreated, it can progress to acquired immunodeficiency syndrome (AIDS), the most severe stage of HIV.

Even after the researchers of the new study made a statistical adjustment to account for age, sex, disease severity, and presence of other health conditions, an HIV infection was still associated with a higher risk of severe disease.

“A final, more sociocultural rather than biological possibility, is that people living with HIV are treated differently than people who do not have HIV when they interface with healthcare systems, including being excluded from accessing certain treatments,” Meyer says, noting that this may be a less likely explanation since the WHO study has a large sample of nearly 170,000 people from 37 countries.

Almost 92% of the participants were being treated with antiretroviral drugs that reduce the amount of HIV in the body.

Those living with HIV but without effective therapy are more likely to be immunocompromised, which can lead to more severe COVID-19, according to Chris Beyrer, MD, epidemiologist at the Johns Hopkins Bloomberg School of Public Health and director of Johns Hopkins HIV Epidemiology and Prevention Sciences Training Program.

Do COVID-19 Vaccines Provide Adequate Protection for People Living With HIV?

There’s no clear data whether COVID-19 vaccines provide the same degree of protection to people who have HIV because fairly small numbers of them were involved in the clinical trials, Beyrer says.

It's possible that they’ll have a weaker immune response to the vaccines, but they should still be prioritized for vaccination, according to the WHO.

“Real-world experience with any of the COVID-19 vaccines, however, have shown them to be highly effective in people living with HIV, and importantly, protective against severe COVID-19 disease,” Meyer says. “It is unclear yet whether anyone will need booster shots, or even a potentially third dose of the primary vaccine series."

Pfizer and Moderna currently have ongoing trials to evaluate the safety and efficacy of their COVID-19 booster shots. However, at a press conference last week, WHO Director Tedros Adhanom Ghebreyesus, PhD said that the companies should instead prioritize increasing vaccine supply to low- and middle-income countries with low vaccination.

Additionally, there is "no scientific evidence to suggest that boosters are definitely needed" and recommendations to use boosters should be based on science and data, not on assertions from manufacturing companies, according to Soumya Swaminathan, MD, chief scientist of the WHO.

“I can imagine a scenario in which extra vaccine doses may be prioritized for people who are severely immunosuppressed, like organ transplant recipients or people undergoing active chemotherapy,” Meyer says. “In that case, perhaps people living with HIV who have an extremely low CD4 count—that is, are severely immunosuppressed—may fall into that category. We’ll have to wait and see.”

Why COVID-19 Vaccination Is Especially Crucial

Getting vaccinated is currently the best available protection a person can have against COVID-19. For people living with HIV, vaccination is especially important because the WHO study suggests that "HIV alone may be a risk factor for severe COVID-19 disease," Meyers adds.

At present, there are about 160 million fully vaccinated Americans. However, many remain unvaccinated due to a number of factors such as the lack of accessibility, misconceptions about vaccine safety, or the lack of opportunity to go to an appointment.

The Biden administration recently announced that they are going to increase their community outreach efforts to address these barriers and make COVID-19 vaccines accessible to more people.

“People living with HIV need access to high efficacy vaccines, including Pfizer, Moderna, and Johnson & Johnson, but in many countries with high HIV rates... these vaccines are not currently available,” Beyrer says.

According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), about 67% of people who have HIV are located in Sub-Saharan Africa. The WHO aims to vaccinate at least 20% of the African population by the end of the year.As of July, less than 3% have had at least one COVID-19 vaccine dose.

In addition, immunosuppression is a risk factor for the prolonged shedding of the COVID-19 virus. This means that patients receiving chemotherapy, solid organ transplant recipients, and people who have HIV may remain infectious for a longer period.

“This can lead to the generation of variants of concern,” Beyrer says. "There is a public health aspect to the interaction of these viral infections, which is also important.”

What This Means For You

If you have HIV and you are not yet vaccinated against COVID-19, you can visit vaccines.gov to look for available vaccine appointments near you. It is important for everyone—immunocompromised or otherwise—to reduce the likelihood of contracting COVID-19 as much as possible.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

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10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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