Journal Article

HIV, ART, and COVID-19

THE BOTTOM LINE:

In a study from Madrid 77,590 HIV-positive persons on antiretroviral therapy (ART) were followed for outcomes over 75 days. Of this group, 236 developed documented COVID-19, and 151 were hospitalized. Men, especially those aged 70 plus years, were more likely to be diagnosed with COVID-19 and admitted to the hospital. However, when the rates of COVID-19 for those with HIV were compared to the general population, they were similar. Of interest, those taking tenofovir disoproxil fumarate (TDF) were less frequently hospitalized than those taking tenofovir alafenamide (TAF), abacavir or other nucleoside reverse transcriptase Inhibitors. In addition, no persons on TDF died. There are possible sources of bias in these results. For example, there may have been selection of those with fewer comorbidities to receive TDF rather than TAF, resulting in less adverse outcomes in the TDF group. In addition, in an abstract reported at the recent International AIDS Conference a large study of US veterans found no increase in COVID-19 in those with HIV and no protective effect of any ART. Clearly, more research is necessary.

ABSTRACT

BACKGROUND

The incidence and severity of coronavirus disease 2019 (COVID-19) among HIV-positive persons receiving antiretroviral therapy (ART) have not been characterized in large populations.

OBJECTIVE

To describe the incidence and severity of COVID-19 by nucleos(t)ide reverse transcriptase inhibitor (NRTI) use among HIV-positive persons receiving ART.

DESIGN

Cohort study.

SETTING

HIV clinics in 60 Spanish hospitals between 1 February and 15 April 2020.

PARTICIPANTS

77 590 HIV-positive persons receiving ART.

MEASUREMENTS

Estimated risks (cumulative incidences) per 10 000 persons and 95% CIs for polymerase chain reaction–confirmed COVID-19 diagnosis, hospitalization, intensive care unit (ICU) admission, and death. Risk and 95% CIs for COVID-19 diagnosis and hospital admission by use of the NRTIs tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC), tenofovir alafenamide (TAF)/FTC, abacavir (ABC)/lamivudine (3TC), and others were estimated through Poisson regression models.

RESULTS

Of 77 590 HIV-positive persons receiving ART, 236 were diagnosed with COVID-19, 151 were hospitalized, 15 were admitted to the ICU, and 20 died. The risks for COVID-19 diagnosis and hospitalization were greater in men and persons older than 70 years. The risk for COVID-19 hospitalization was 20.3 (95% CI, 15.2 to 26.7) among patients receiving TAF/FTC, 10.5 (CI, 5.6 to 17.9) among those receiving TDF/FTC, 23.4 (CI, 17.2 to 31.1) among those receiving ABC/3TC, and 20.0 (CI, 14.2 to 27.3) for those receiving other regimens. The corresponding risks for COVID-19 diagnosis were 39.1 (CI, 31.8 to 47.6), 16.9 (CI, 10.5 to 25.9), 28.3 (CI, 21.5 to 36.7), and 29.7 (CI, 22.6 to 38.4), respectively. No patient receiving TDF/FTC was admitted to the ICU or died.

CONCLUSION

HIV-positive patients receiving TDF/FTC have a lower risk for COVID-19 and related hospitalization than those receiving other therapies. These findings warrant further investigation in HIV preexposure prophylaxis studies and randomized trials in persons without HIV.

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