Fewer but More Often Severe COVID Cases in People Living With HIV, Study Suggests

NEW YORK (Reuters Health) – People living with HIV do not appear to be at higher risk of SARS-CoV-2 infection, but they may have more severe disease than people without HIV, researchers report.

The results also “raise concern” that the immune response to SARS-CoV-2 infection could be blunted in people with HIV, given that neutralizing antibody titers and IgG concentrations were markedly lower in people with HIV, they report in The Lancet HIV.

“People living with HIV should be followed up after vaccination, with antibody and T-cell activity measured when possible, to ensure they mount a sufficient immune response to prevent cases of severe COVID-19,” write Dr. Matthew Spinelli of the University of California, San Francisco, and colleagues.

They did a matched case-control study of 955 people with HIV and 1,062 people without HIV infection who underwent routine outpatient laboratory testing at San Francisco General Hospital.

They collected 1,138 serum samples from people with HIV and 1,118 samples from people without HIV over a three-month period in 2020 (August-October).

SARS-CoV-2 seroprevalence was lower in people with than without HIV (3.7% vs. 7.4%; adjusted odds ratio, 0.5; 95% confidence interval, 0.3 to 0.83).

Among 31 people with HIV and 70 people without HIV who had evidence of previous SARS-CoV-2 infection, the likelihood of severe COVID-19 was 5.52-fold higher in the HIV group, independent of age and sex (95% CI, 1.01 to 64.48).

Among those with a prior positive PCR test, IgG concentrations were 53% lower and neutralizing antibody titers were 67% lower among people with HIV than among those without HIV.

“Future studies will need to follow up people living with HIV after natural infection to measure humoral and T-cell immune responses and ensure sufficient protection,” Dr. Spinelli and colleagues say.

The authors of a linked comment say this study shows that people with HIV can be “reassured that they are not at increased risk of getting infected when appropriate preventive measures are taken.”

However, the “low numbers of severe cases of COVID-19 (seven in the whole cohort) does not allow conclusions regarding risk of severe disease in people with HIV,” they point out.

“An important and original finding” of the study is the lower total SARS-CoV-2- specific IgG and pseudovirus neutralizing antibody concentrations found after natural infection, which could put people with HIV at higher risk of reinfection, write Dr. Nicolas Dauby and Dr. Charlotte Martin with the Free University of Brussels, in Belgium.

These observations also recall the “well characterized dysfunctional vaccine responses observed in people with HIV. Large prospective studies assessing the magnitude and the durability of COVID-19 vaccine-induced antibody response in people with HIV are required. If the latter report suboptimal immune response to COVID-19 vaccines, people with HIV (or particular subgroups of people with HIV) could benefit from distinct immunization strategies with improved immunogenicity, such as an adapted vaccine schedule (additional doses and heterologous revaccination) or use of specific vaccine platform, as with influenza vaccination,” they conclude.

Funding for the study was provided by the US National Institute of Allergy and Infectious Diseases, National Institutes of Health. The authors have no relevant disclosures.

SOURCE: https://bit.ly/3tEjFaC and https://bit.ly/3y3kahI The Lancet HIV, online April 29, 2021.

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