Part of the 23rd International AIDS Conference, (AIDS 2020: Virtual), 6 – 10 July 2020 focused on COVID-19 and its effect on people living with HIV (PLHIV). Here is a brief summary that may be of interest. The AIDSmap site provides excellent summaries about all the topics covered at the Conference.
Are people living with HIV more at risk of COVID-19?
A large US study presented at the recent 23rd International AIDS Conference, AIDS 2020: Virtual), reported that PLHIV were not more likely to contract the Coronavirus. Those who did were not more likely to develop severe COVID-19. Researchers found that people with HIV had higher testing rates but that this did not result in a higher rate of positivity among those tested.
Other studies from around the world including London and New York City reported similar findings. However one study from South Africa did report a modest increase in mortality for people living with HIV. It was acknowledged that it was people with a high viral load and low CD4 count who had a somewhat higher risk of death.
Why does COVID-19 cause some people to become more unwell than others?
Another important question discussed at the Conference was ‘Why do some people become much sicker than 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. (The immune system usually uses proteins known as cytokines to fight disease). HIV targets the immune system, so researchers at Mount Sinai in New York explored whether this prevented the release of cytokines and therefore provided some protection from severe COVID-19 disease for PLHIV
However, they found PLHIV, who died from COVID-19, still produced large numbers of cytokines irrespective of CD4 count and HIV viral load, with higher cytokine levels than those who survived.
You can read about this and other stories about HIV and COVID -19 here. aidsmap.com/news/…/hiv-aids-2020
Impact of COVID-19 on sexual behaviour and PrEP use
COVID-19 has had an extensive impact on PrEP with lockdowns in USA and Australia contributing to substantial reductions in sexual activity and PrEP use by gay men. These findings were from studies also presented to the Conference (AIDS 2020)
A cohort of 940 gay and bisexual men in Australia were surveyed about sexual behaviour pre- and post-COVID-19. Participants reported a 65% reduction in sex with recurring but casual partners and a 58% reduction in sex with casual partners. Prior to COVID-19, 46% had been on PrEP and 58% continued to use it. Of those stopping PrEP, 86% gave COVID-19 as one of the reasons, but only 17% reported that they had found it difficult to access PrEP during this time. Dr Mohamed Hammoud of UNSW Kirby Institute concluded that COVID-19 could be an opportunity to expand PrEP on demand and other dosing options.
A survey of 394 PrEP users and 188 healthcare providers across the United States demonstrated similar themes of behavioural change and reduction of PrEP uptake, generally by choice rather than a lack of access.
Both studies concluded that when lockdowns eased there could be an increase in HIV transmission if countries did not have plans in place to manage an increase in sexual activity and a timely resumption of PrEP.