Since the beginning of the coronavirus 2019 (COVID-19) pandemic, there has been enormous interest in understanding the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on people with HIV (PWH). Given the higher risk of severe outcomes from other respiratory infections such as influenza and pneumococcal pneumonia for PWH, clinicians were concerned there might be a similar elevated risk for this new viral infection. Additionally, it quickly became clear that many common comorbidities found in PWH, including obesity, diabetes, and cardiovascular disease, were risk factors for severe COVID-19 outcomes. Although there is still much to learn, some preliminary conclusions can now be made based on the accumulated global experience to date. We will primarily address 4 key questions: 1) Are PWH at increased risk for SARS-CoV-2 infection; 2) Are they at higher risk for hospitalization after diagnosis; 3) Is HIV status or degree of HIV-related immune deficiency a risk for severe outcomes; and 4) Do antiretrovirals used for HIV have activity against SARS-CoV-2.
From the extensive global experience reported to date, risk for severe COVID-19 is largely driven by age and non-HIV comorbidities, similar to what is seen for people without HIV. However, those with CD4 cell counts under 200 may be at elevated risk for worse outcomes. Infection risk is driven by similar social determinants of health that define risk for HIV infection. Study findings have inconsistently shown increased rates of hospitalization, but this is more likely due to a lower threshold for admission for PWH. There is no evidence for clinically meaningful activity of any HIV antiretrovirals against SARS-CoV-2. One area of possible significant impact on PWH, but with too little data to date, concerns the effects of pandemic-related care disruption on HIV outcomes.