HIV Emerges as Significant Risk for Severe COVID HIV, Hepatitis & Sexually Transmitted Infections 15/07/2021 • Kerry Cullinan & Paul Adepoju Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window) A community health worker and counsellor tests a sample of blood to ascertain whether the donor is HIV positive or negative. People living with HIV face a significant risk of severe COVID-19 and should be prioritised in national vaccination programmes, according to research presented on Thursday ahead of the International AIDS Society’s (IAS) HIV Science conference which starts on Saturday. The World Health Organization (WHO) research looked at the data of 15,500 HIV positive people from 24 countries who had been hospitalised for COVID-19. “Among patients with a known outcome, 23% died in hospital,” according to IAS. After adjusting for age, sex and co-morbidities, the study team determined that HIV infection was associated with an increased risk of severe COVID-19 and death in hospital. Almost 95% of cases were from South Africa, the epicentre of the world’s HIV pandemic, and researchers found that HIV positive Africans hospitalised for COVID-19 were at a greater risk of death than those from Europe and the Americas. “This study underscores the importance of prioritising all people living with HIV in national COVID-19 vaccine programmes,” said IAS President and IAS 2021 International Co-Chair Adeeba Kamarulzaman. “The global community must do more to ensure immediate vaccine supply to countries with high HIV disease prevalence. It is unacceptable that as of today, less than 3% of the entire African continent has received a single dose of the vaccine and less than 1.5% have received both doses.” Speakers at a IAS 2021 press briefing on Monday noted that previous publications on the impact of HIV on COVID were conflicting with some publications noting that HIV had no impact while this latest study showed significant contribution of HIV to the COVID-19 pandemic. Dr Steven Deeks, Professor of Medicine in Residence Division of HIV, Infectious Diseases and Global Medicine at the University of California San Francisco noted that the study was among people in hospital which is not the whole pandemic. He described it as a very large study, which means it has more power “to see something”, and it is global with most of the events occurring in resource-limited areas. “To me it is not surprising because every time we look at things carefully we can find something there. People on multi-therapy, their immune system is certainly good but is not optimal — particularly people with lower CD4 count. So one will expect what this study found. But the bottomline is because of the size of the study and global reach, this is closer to the truth than the previous studies,” Deeks said. Sexual Violence and HIV Exposure During Uganda’s COVID-19 Lockdown Research from a large Ugandan study showed that women face increased risk of gender-based violence and HIV during COVID-19 lockdowns, according to the IAS at its pre-conference media briefing. Researchers analysed routine data from the Uganda Health Management System and the Uganda Child Helpline to correlate COVID-19 restrictions with gender-based violence reports, uptake of HIV post-exposure prophylaxis (PEP) and teen pregnancy among Ugandan women and girls. They compared data from six months prior to COVID-19, starting in October 2019, and the first six months of COVID-19 restrictions, starting in April 2020. During the first six months of COVID-19 restrictions, there was a 24% increase in post-rape reports and an 18% reduction in PEP uptake compared with the pre-COVID-19 period. More than half of those who reported for post-rape care after the recommended 72-hour PEP intervention timeframe said that lockdown restrictions had prevented them from getting treatment. The study team also found that among Ugandan girls, the odds of reporting sexual violence during the COVID-19 period was 1.3 times higher than in the pre-COVID-19 period. There was also a 17% increase in teen pregnancy between the two periods, but that was not found to be statistically significant. “There has been a lot of concern about the potential for COVID-19 lockdowns to fuel what UN Women has called the ‘shadow pandemic’ of increased gender-based violence and unintended pregnancy. This study confirms that HIV risk is also a major concern that should be taken into account when designing pandemic response plans,” Kamarulzaman said. Improved Treatment for drug-resistant TB But there was also some good news for improving the treatment of highly drug-resistant tuberculosis (TB). TB is the most common opportunistic infection to prey on people with HIV, and drug-resistant TB is notoriously difficult to cure and the drugs have significant side-effects. Some 181 people with highly drug-resistant TB were treated for six months with daily bedaquiline and pretomanid, and daily linezolid (a combined regimen known as BPaL) starting at 1,200mg for either six or two months or 600mg for either six or two months. “A high relapse-free cure rate was observed in all four study arms. In addition, people who received reduced doses and/or shorter durations of linezolid were less likely to experience adverse events of peripheral neuropathy and myelosuppression,” according to the study, conducted in South Africa, Russia, Georgia, and Moldova. The results suggest that reduced doses and shorter durations of linezolid have similar efficacy and improved safety. Still on TB, IAS 2021 co-chair, Prof Hendrik Streeck, noted that on Sunday 18 July, the 100th year anniversary of the first administration of the BCG vaccine will be celebrated. “It is a vaccine that saves many lives but has very limited effectiveness. And is still the only TB vaccine we have so far. I hope this anniversary will be an opportunity to remind the world of the really urgent need for improved TB prevention and treatment options,” Streeck said. The IAS virtual conference will be opened on Sunday by German Chancellor Angela Merkel, and includes a panel discussion on the COVID-19 and HIV pandemics with Dr Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases. Kamarulzaman noted that with the HIV pandemic now in its 40th year and about 35 million lives have been lost till date, the key message at this critical juncture is to follow the science. “Forty years of HIV research has informed the global response to COVID-19. We now have new opportunities to adapt and enhance COVID-19 approaches and to leverage new global enthusiasm for public health, especially vaccine science,” Kamarulzaman said. Image Credits: Flickr, Nick Youngson. 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