by Christina Blanchard-Horan, Ph.D. and Marsha Greene, Ph.D.
I was talking with a colleague the other day about COVID-19 and the HIV community. There are an estimated 38 million people living with AIDS worldwide. Since I spent years working with the HIV communities in Africa, Asia, and the US, I thought I would look into this and share my findings in one place and in lay terms. Undoubtedly, many people with HIV and other immune disorders are concerned about their risk of getting COVID and what would happen if they got the virus. I have read a number of stories about people so frightened they have self-isolated for the past year! So I decided to put together this article about HIV and COVID in hopes it would shed some light on this issue.
Let’s start off by acknowledging that CDC indicated in a study released in 2019 that HIV-positive persons on their medication were at no greater risk of getting COVID than any other person taking the same precautions (https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/hiv.html). So what are we interested in knowing?
But wait!
As new studies revealed, this may not be so. Another study released in May 2021 in Scientific Reports said that Penn State College of Medicine researchers found that people living with HIV actually had a 24% higher risk of SARS-CoV-2 infection.
Questions
This leaves two main questions that remain to be answered for people who are HIV positive.
Does the vaccine work on people with suppressed immune systems?
What happens when an HIV-Positive person gets COVID?
Millions of Americans live with immune disorders and autoimmune diseases like HIV, lupus, rheumatoid arthritis, and Crohn’s disease. Their treatment requires that they take immune-suppressing drugs, usually for life. Transplant patients also require immune-suppressing drugs. The purpose of their medication is to reduce the body’s immune response to fight the foreign body, i.e., the new organ (Scheffert JL, Raza K. Immunosuppression in lung transplantation. J Thorac Dis. 2014;6(8):1039-1053. doi:10.3978/j.issn.2072-1439.2014.04.23).
Unfortunately, there is little information about the protections provided by vaccines. People with compromised immune systems have largely been excluded from the Covid-19 vaccine trials in the U.S., and abroad.
Viral Load
Here’s what we know. A recent study by researchers at Johns Hopkins University found that only half of organ transplant recipients developed antibodies after two doses of a COVID-19 vaccine. This means that people with immune-compromised systems may have trouble developing the antibodies needed to fight COVID-19.
This research was recently released but has not yet been peer-reviewed. It considers intentionally immunocompromised individuals, lung transplant patients to see how they responded to the vaccine. The results were not very good news. It suggests that COVID vaccines may not protect people with immune disorders.
COVID vaccines may not protect people with immune disorders
We learn in the Serological study evaluating Pfizer and Moderna vaccines that after the 2nd regimen in lung transplant patients most participants did not develop “appreciable anti-spike antibody responses.”
In this next study, the researchers conclude that “…poor anti spike antibody responses in organ transplant recipients after the first dose of mRNA vaccines suggest that such patients may remain at higher early risk for COVID-19 despite vaccination (, , , et al, 2021). Deeper immunophenotyping of transplant recipients after vaccination, including characterization of memory B-cell and T-cell responses, will be important in determining vaccination strategies as well as immunologic responses after the second dose.” (Brian J. Boyarsky, MD1; William A. Werbel, MD2; Robin K. Avery, MD2; et al., March 2021). In other words, more research is required.
HIV Positive with COVID Diagnosis
The next question I asked was, what happens if you get COVID and have an HIV diagnosis? A colleague at NIH forwarded a cohort study that was conducted in New York State. It looked at persons with an HIV diagnosis compared with people who had a negative diagnosis.
This research was conducted in New York Hospitals and results suggest that persons with an HIV diagnosis experienced poorer COVID-related outcomes when compared to non-HIV positive persons. Researchers found that those people with an HIV diagnosis had higher rates of severe disease requiring hospitalizations. And the sicker the person, the more severe the hospitalization. They state in this article that COVID-19 deaths among persons living with an HIV diagnosis were considerably higher than their counterparts with no HIV diagnosis. That study I mentioned earlier at Penn State, found that people with HIV had a 78% higher risk of death from COVID-19 than people without HIV.
COVID deaths were higher among people with an HIV diagnosis
Immunocompromised
According to an early press release sent to NIH on 17 May 2021, Children’s National Hospital released their findings showed vaccine recipients who were taking medications that suppress their immune system had a significantly weaker response to the vaccine than healthy people.
In the aforementioned study by Brian et. al. (March 2021) HIV status contributed significantly to in-hospital mortality among hospitalized persons with COVID and aged 40 years or older. Brian et al further suggest that these people were also 3 to 4 times more likely to die in the hospital than those who tested negative.