Review of research into SARS-CoV-2 and HIV coinfection

A review paper on HIV and COVID-19 published in the May 2021 edition of Lancet HIV is useful for an overview of issues and covers more than 120 studies. The rapid pace of research though means that some of the key discussions do not include the most recent studies.

The review discusses implications of HIV infection and immune responses that might affect the pathogenesis of COVID-19. Two studies have so far reported that the concentration and duration of IgG, IgM, and neutralising antibodies do not appear to be affected by HIV infection, although a third study reported a lower rate of neutralising antibodies. It also discusses the inflammatory status of both infections, especially if HIV viral load is not suppressed on ART. Also, the difficult issue that if uncontrolled HIV and lower CD4 counts result in longer periods of SARS-CoV-2 shedding, this might allow for easier development of viral variants.

The article raises the question of whether PCR and antibody testing need to be validated for HIV positive people although there is currently no data to inform the answer.

Although the review reports on clinical and epidemiology results from studies with at least 50 HIV positive cases, this only covers studies published up until November 2020. This also limits the applicability of the review of potential treatments for COVID-19.

Other important issues are also discussed, including mental health and vaccine access.