HIV carriers a fifth as likely to die from coronavirus, Madrid study suggests

Stephen Chen

The new coronavirus is much less likely to kill people who also have HIV, according to a study by Spanish scientists.

People with HIV (human immunodeficiency virus) can theoretically die from a common cold because of their weakened immune system. But in Madrid the mortality rate of HIV-positive people who contracted Covid-19, the disease caused by the coronavirus, was a fifth of that of non-HIV patients who had Covid-19, according to a study published in journal The Lancet last Thursday.

The results in the Spanish capital followed an earlier clinical observation in China that some patients taking a therapy for Aids – the condition caused by HIV – were almost entirely spared by Covid-19.

Scientists believe discovering the reason could improve understanding of Sars-CoV-2, the coronavirus’ scientific name, and aid the development of drugs and vaccines to contain its global spread.

Dr Pilar Vizcarra and colleagues from the Hospital Universitario Ramon y Cajal examined the medical records of nearly 3,000 HIV-infected individuals and identified 51 Covid-19 cases – an infection rate of 1.7 per cent, compared with 4 per cent for Madrid’s overall population.

“To our knowledge, this is the first study to comprehensively describe the infection rate of Covid-19 in people living with HIV compared with the general population in the same region,” Vizcarra wrote in the paper.

Only two of those patients with the double infection had died, representing a mortality rate of about 4 per cent, on a par with the Covid-19 death rate in some countries such as the United States but remarkably low in the Madrid region, which has a 20 per cent fatality rate.

But the report of the study said this did not mean the coronavirus posed no danger to people with HIV.

“Despite the low mortality rate, 25 per cent of HIV-infected individuals with Covid-19 had severe disease and 12 per cent were admitted to an [intensive care unit], which is a higher rate than that observed in cohorts of the general population,” the researchers said.

The coronavirus also increased the chances of additional conditions such as high blood pressure and kidney failure, they found.

Taken together, these results suggested “there were no significant differences in clinical characteristics, treatments or outcomes” between HIV-positive people and the rest of the population, according to the study.

Scientists have found some striking similarities between Sars-CoV-2 and HIV. For instance, a team from the Sun Yat-sen University in Guangzhou, southern China, found that the two viruses used the same strategy to evade attack by the human immune system. The two viruses have also been found to use similar tactics to enter a host cell.

Some scientists have suspected that low death rates of Covid-19 patients with HIV could be linked to the antiviral therapies that they were taking, along with them isolating more cautiously and being less prone to an overreacting immune response.

Some HIV drugs interfere with the binding of that virus to host cells, and may have a similar effect on the coronavirus. A study by Chinese researchers in Wuhan, the coronavirus outbreak’s initial epicentre, found no cases of Covid-19 among nearly 200 HIV patients taking lopinavir and ritonavir, two important drugs in the HIV-suppressing cocktail approved for medical use since 2000.

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Wang Guangfa, a respiratory expert who was infected after having contact with the earliest identified patients in Wuhan, also told Chinese media after his recovery that lopinavir had given him “a big help”.

There is so far no solid scientific evidence from large-scale studies that can prove anti-HIV drugs are effective against Covid-19.

Vizcarra’s team found that lopinavir did not improve Covid-19 patients’ condition, but that tenofovir, another antiviral medicine widely used to treat HIV, showed some potential for doing so.

Professor Gu Chaojiang, a life scientist studying HIV and Sars-CoV-2 at the Wuhan University of Science and Technology, said that the genes of the two were quite different, but that they shared a very similar structure in the spiky protein that binds the virus to a host cell.

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“There is a reasonable hope to find a Covid-19 cure in anti-HIV drugs,” he said.

The similarity between the two viruses also increased the likelihood of Covid-19 being a persistent infection like Aids, according to Gu, although the coronavirus does not mutate as quickly as HIV.

“If countries can work together to suppress the outbreak, we can slow down its evolution,” Gu said. “Otherwise, vaccines or drugs developed based on genetic information at the early stage of the outbreak may not work in the end.”

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