Here’s why people with HIV should be prioritized for Covid vaccines and boosters

The World Health Organization announced last month that people living with HIV should be among those prioritized for Covid vaccines. The announcement came at the 11th International AIDS Society Conference on HIV Science (IAS 2021) in Berlin in mid-July.

It followed the results of a large-scale study on the risk of Covid to those living with HIV. Previous studies had presented slightly conflicting findings on this issue. However, many of those studies were comparatively small in scale.

This particular research was an analysis of over a quarter of a million people hospitalized with Covid in 37 different countries. Ninety-five percent were from South Africa, where HIV is a particular problem.

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Of these, 15,522 people were HIV positive. A third of those with HIV were severely ill at the time of their admission with Covid, and a quarter of those admitted to hospital died. This was most pronounced in men aged over 65 with HIV (who made up 90% of those severely ill), or anyone with diabetes or high blood pressure.

The research was led by Dr. Silvia Bertagnolio, an HIV researcher at the World Health Organization. She and her colleagues, once they’d made adjustments for age and other health risk factors (such as obesity and diabetes), calculated that people with HIV who contract Covid have a 30% increased chance of dying.

They also found people living with HIV were 13% more likely to be admitted to the hospital with severe or critical COVID-19.

The results were most pronounced in those in Africa, but less so for those in Europe or the Americas. However, because far fewer of the cases came from the latter territories, analysts say not too much should be read into that difference.

“HIV knocks out all the brakes on the immune system, and as a consequence, you get this inflammatory response that’s robust and sustained — and now you got Covid on top of that,” Dr. Steven Deeks, an HIV expert at the University of California, San Francisco, told New York Times. “I would be surprised if HIV was not associated with progression” of Covid-19.

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Deeks actually thought the study’s calculation of 30% could be a conservative one, given that HIV itself has been linked to obesity and diabetes. He believes this makes it difficult to accurately make adjustments to remove those other health factors.

This latest study comes up with a similar result to research published in England in January. It too concluded: “People with HIV in the UK seem to be at increased risk of COVID-19 mortality. Targeted policies should be considered to address this raised risk as the pandemic response evolves.”

Although the size of this new research adds extra credibility, this larger study did not include data on CD4 counts or viral load. Indeed, the authors acknowledged this as one of their work’s limitations.

They had wanted to include an analysis of how viral load and CD4 count impacted Covid outcomes, but “information about ART use was not available in 40% of the cases,” according to lead author Dr. Bertagnolio. Because of this, they were unable to draw any conclusions on how viral load impacts Covid severity.

This led WHO to advise all people with HIV should be prioritized when it comes to Covid vaccines and potential booster shots further down the line, irrespective of their viral load or CD4 count.

“From these data, we cannot draw any conclusions on how and if viral load levels or CD4 cell count may impact the severity or mortality of PLHIV [People Living with HIV] hospitalized with COVID-19,” Dr. Bertagnolio told Queerty.

“We hope that ART information will be reported to the WHO Clinical Platform by an increasing number of cases, as this will enable us to assess the impact of ART in future analysis.”

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Other studies have suggested that Covid is not a greater problem for those with undetectable HIV, but poses an increased risk for anyone whose HIV is out of control.

For example, a Spanish study that also reported its findings at IAS 2021, found that HIV-positive people with a detectable viral load and a CD4 count below 500 were at greater risk of severe COVID-19. This risk was heightened further if the individuals had what is known as co-morbidities: health conditions such as high blood pressure, cardiovascular disease, chronic kidney disease, or cancer.

Matthew Hodson, Chief Executive of HIV information organization NAM aidsmap, told Queerty, “The increased risk of illness and death this data shows means that we at NAM Aidsmap fully support the decision made by at least 40 countries to prioritize people with HIV for COVID-19 vaccination.

“Data on COVID risk from countries where larger proportions of people with HIV are on effective HIV treatment suggests that treatment’s strengthening of the immune system helps people with HIV avoid severe COVID outcomes.

“The WHO data highlights that people living with HIV also carry a higher burden of other conditions that may make them more vulnerable to COVID, some of which may be related to their HIV infection.

“It also underlines the importance of people knowing their HIV status, having access to HIV medication, and being adherent to their treatment, as untreated HIV will make an individual far more vulnerable to severe COVID illness or death.”