People living with HIV are potentially more susceptible to a severe clinical course of COVID-19 than those who are HIV-negative, according to a study published in The Lancet which has provided fresh insight into the link between HIV and severe COVID-19.
Amongst people who are HIV-positive, individuals with a low CD4 cell count — an indication of the number of white blood cells in the body — are thought to potentially be more susceptible to cases of severe COVID-19. The link is thought to be associated with the fact that immunocompromised individuals are at a higher risk of acquiring infections that persist for a longer duration of time.
Virus‐specific CD4 and CD8 cells play a critical role in clearing viral infections, and dysfunctional immune responses contribute to disease progression. This highlights why defective cell immunity, and broader immune deficiency, is associated with susceptibility to COVID-19.
The Lancet study notes that “broad, strong CD4 and CD8 memory cell responses are observed in recovered patients, suggesting that coordinated antigen-specific B-cell and T-cell responses provide protective immunity against severe COVID-19 infection and death.”
Examinations of a cohort of 175 patients with a COVID-19 infection diagnosed in three countries during the first months of the pandemic showed that patients with severe COVID‐19 had a lower current CD4 cell count. An immune deficiency consisting of a CD4 cell count lower than 350 per microliter was identified to be associated with an almost three‐fold risk for severe disease.
Building on this, further analysis — including a case report from a tertiary care hospital in northern India — suggests that comorbid conditions might be responsible for the increased hospitalisation and mortality in immunocompromised HIV patients with lower CD4 cell counts. Yet, despite these suggestions, literature linking the risk between HIV and COVID-19 remains sparse. This has prompted comments, such as those published in The Lancet in January 2021, urging caution in how we interpret any links between people living with HIV and cases of COVID-19 mortality.
The authors — Anton L Pozniak and Laura J Waters — suggested that, “there is uncertainty as to the role of severe immunosuppression or uncontrolled viraemia in the risk for severe COVID-19 and death.”
Disruption to treatment
What is clear is that the COVID-19 pandemic has had a clear impact on HIV prevention and treatment services worldwide. Challenges presented by disruption have seen increased strain on individuals living with HIV.
For India, a country with the third largest population of people living with HIV globally, the impact of COVID-19 on nonadherence to antiretroviral therapy and other forms of treatment becomes a large scale prospect.
Research published in BMC Public Health analysing anxiety among people living with HIV during the COVID-19 pandemic offered insight into this disruption. It highlighted that anxiety among people living with HIV “will likely increase with the worsening pandemic in India…we recommend the regular use of short screening tools for anxiety to monitor and triage patients as an extension of current HIV services.”
This is now particularly pertinent as the worsening COVID-19 situation in India continues to unfold with hospitals now left in a situation where they are simply unable to save everyone through lack of resources.
And whilst studies examining potential links between HIV and severe COVID-19 have called for the need to develop increased understanding of any links, the main arguments have been centered around a requirement to ensure disruption to HIV treatment and management is kept to an absolute minimum.