One ART Regimen Tied to Lower COVID-19 Risk in HIV

A certain regimen of antiretroviral therapy (ART) may have contributed to lower COVID-19 incidence and severity among people living with HIV, researchers in Spain found.

Risk of COVID-19 diagnosis and hospitalization was lower for people living with HIV receiving Truvada, or tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC), compared with those on

other ART regimens, as well as the Spanish population ages 20-79, reported Julia del Amo, MD, PhD, of the National Plan Against AIDS in Madrid, and colleagues.

Moreover, the risk of COVID-19 diagnosis was not higher among people living with HIV on ART than the general population of Spain, they wrote in the Annals of Internal Medicine.

The authors added their findings warranted further study into HIV pre-exposure prophylaxis (PrEP) as potential treatment or prevention of COVID-19 in people without HIV.

Evidence has been mixed about the role of HIV infection in COVID-19, with the authors stating the disease may be more severe among this population because other risk factors, such as older

age, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), and kidney disease, are common among people living with HIV.

"The lack of increased risk for serious COVID-19 among HIV-positive persons might be the result of their use of ART," they wrote, adding ART was proposed as a protective factor against SARS

in 2003, but there were too few cases to draw meaningful conclusions about its role.

On June 25, the CDC added "immunocompromised state," including a weakened immune system from HIV infection, as a condition that may increase risk for contracting severe COVID-19.

Researchers here examined data from HIV clinics of 60 hospitals in Spain from February 1 to April 15. They looked at HIV-positive patients with laboratory-confirmed COVID-19 who were

receiving an ART, and analyzed the national COVID-19 Health Information System for age and sex distribution.

Among 77,950 HIV-positive people receiving ART, there were 236 COVID-19 diagnoses. Of these, 64% were hospitalized, 6% were admitted to the ICU and 8% died.

Not surprisingly, risks for COVID-19 diagnosis among HIV-positive people on ART was highest for those older than age 70, with risks of hospitalization, ICU admission, and death increasing

with age.

The most common nucleos(t)ide reverse transcriptase inhibitor (NRTI) backbone was tenofovir alafenamide (TAF)/FTC, or Descovy (33%), followed by abacavir (ABC)/lamivudine (3TC) and TDF/FTC

(16%). However, only 9% of those diagnosed with COVID-19 were taking TDF/FTC, though the proportions of those receiving other regimens was similar among those with and without COVID-19, the

authors noted.

Researchers estimated a risk for COVID-19 diagnosis of 30.0 per 10.000 and 3.7 per 10,000 for death among HIV-positive people receiving ART. By contrast, the Spanish population ages 20-79

was 33.0 per 10,000 (after healthcare workers were excluded) and 2.1 per 10,000, respectively.

But after stratifying by NRTI backbone, people on TDF/FTC had the lowest risk of diagnosis and hospitalization (16.9 and 10.5, respectively).

The authors also found risks for diagnosis and hospitalization were 57% and 48% lower, respectively, among those who received TDF/FTC and TAF/FTC.

These findings were puzzling, according to the authors, who said they could not think of any mechanism to explain why the TDF/FTC group would have lower risks of COVID-19 infection. But they

also cautioned there were a number of caveats with the comparisons with the general public, including "inevitable reporting delays" due to the public health emergency.

The study was supported by Instituto de Salud Carlos III and the NIH.

del Amo and co-authors disclosed no relevant relationships with industry.