People with HIV at high risk of severe Covid-19

INTERNATIONAL health organisations have called for prioritisation of people living with HIV in the Covid-19 vaccination programme following revelations by the World Health Organisation (WHO) that the group was at risk of contracting severe illness from the respiratory virus and in-hospital mortality.

This was revealed yesterday during a virtual press briefing ahead of the International AIDS Society (IAS) conference on HIV Science which will kick off in Berlin, Germany on Sunday.

Previous evidence regarding the impact of HIV infection on the severity and mortality of Covid-19 has been limited and sometimes conflicting, and most analyses have been based on a relatively small cohort of individuals in specific settings.

Informed by these findings, the IAS called on countries to add people living with HIV to the list of prioritised groups in vaccine efforts.

"This study underscores the importance of countries including all people living with HIV in the list of priority populations for national Covid-19 vaccine programmes," IAS president and IAS 2021 International co-chair Adeeba Kamarulzaman said during the virtual address.

"The global community must also do much more to bring Covid-19 vaccines to countries around the world with high prevalence of HIV and other diseases. 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."

In this report, WHO researchers analysed clinical data submitted to the WHO Global Clinical Platform for Covid-19 from 24 countries on more than 15 500 people living with HIV who were hospitalised for Covid-19.

The mean age of these patients was 45,5 years. About 37% were male, and about 92% had received antiretroviral therapy and about 36% had severe or critical Covid-19 illness on admission. Their most common underlying chronic conditions were hypertension, diabetes and obesity.

Among patients with a known outcome, 23% died in hospital. The study team determined that HIV infection was associated with an increased risk of severe or critical Covid-19 presentation.

This new development will, however, pose a huge challenge for people living with HIV in Zimbabwe since the vaccination process has been marred by long queues with many people being turned away.

While President Emmerson Mnangagwa has said the government was expecting to vaccinate a million people during the two weeks of extended lockdown, the pace on the ground and the availability of the vaccines are questionable.

During the WHO briefing results were shared which showed high rates of HIV drug resistance in a pre-exposure prophylaxis ( PrEP) trial rollout which included participants from Zimbabwe.

PrEP is medicine taken to prevent HIV. It reduces the risk of getting HIV from sex by about 99%.

A study from the Global Evaluation of Microbicide Sensitivity (GEMS) project found high rates of drug resistance in individuals who were diagnosed with HIV while participating in the PrEP rollout programmes in sub-Saharan Africa.

These participants, including Zimbabweans had a median age of 24 and threequarters were female.

A total of 104 of the 175 samples were successfully genotyped and at least one major HIV drug-resistant mutation was detected in 45% of them.

"Drug resistance in PrEP breakthrough infections could threaten treatment effectiveness, contribute to the spread of resistance and undermine efforts to prevent HIV," said

IAS 2021 local co-chair Hendrik Streeck, who is the director of the Institute of Virology and Professor of HIV Research at the University of Bonn in Germany.