Health outcomes in HIV-positive people in San Francisco with COVID-19

Another team of researchers in San Francisco analysed health-related and limited socio-economic information on HIV-positive people who were diagnosed with COVID-19 between March and September 2020.

Out of 4,252 COVID-19 tests done by HIV-positive people during this time, 194 (almost 5%) were positive for the coronavirus. Among 272,555 HIV-negative people who had COVID-19 tests, about 4% were positive for the coronavirus.

Co-infection with SARS-CoV-2

The average profile of HIV-positive people co-infected with SARS-CoV-2 was as follows:

• age – 45 years
• major ethno-racial groups: white – 39%; Hispanic – 38%; black – 12%; Asian – 7%
• gender – 91% men, 6% women, 3% transgender women
• 64% had been HIV positive for at least a decade
• 44% had an undetectable viral load at their last laboratory visit
• the distribution of CD4+ cell counts was as follows: 63% had more than 500 cells/mm³; 31% had between 200 and 500 cells/mm³; 6% had less than 200 cells/mm³

Interviews

Healthcare personnel were able to interview most (95%) of the HIV-positive people who were diagnosed with COVID-19. The researchers found that only 55% of them had stable housing.

Nearly 25% of participants disclosed that they had contact with someone diagnosed with COVID-19. This is not surprising, as early in the pandemic there was an outbreak of the coronavirus at a homeless shelter in San Francisco.

A large proportion of participants (43%) disclosed that they had underlying conditions, most of which are associated with more severe manifestations of COVID-19:

• cardiovascular disease
• diabetes
• chronic liver disease
• chronic lung disease

The researchers found that 9% of patients currently smoked tobacco and 11% were former smokers.

Symptoms

Common symptoms of COVID-19 were as follows:

• cough
• fever
• runny nose
• muscle pain
• headache
• chills
• breathing problems
• sore throat
• loss of smell and/or taste

About 8% of co-infected people required hospitalization and two people needed to be admitted to an intensive care unit. No one died.

Bear in mind

The researchers stated that data from this analysis are similar to those reported from large European and U.S. studies “suggesting that HIV does not seem to predispose people to more severe COVID-19 outcomes.”

The San Francisco study also suggests that HIV-positive people are at increased risk for SARS-CoV-2 co-infection. The researchers stated that this increased risk arises because many HIV-positive people in this study lived in crowded places such as “single residency hotels, homeless shelters and long-term care facilities.” Also, they stated that “shared bathrooms and crowded spaces make social distancing challenging.”

The coronavirus pandemic has had a disruptive impact on the health of many people and their ability to gain routine access to the full range of health services usually available. Furthermore, according to the San Francisco Department of Public Health, new cases of HIV have increased as the pandemic has intensified.

What is to be done?

The researchers noted that the city has taken steps to reduce the spread of coronavirus among vulnerable populations, including those with HIV. However, they stated, “more efforts are needed citywide to house those who are homeless as a public health measure.” They added that “medical care of homeless individuals with and without HIV is paramount during a pandemic. Housing assistance, continuation of antiretroviral therapy (ART), and continuation of care are required as we try to protect people living with HIV from SARS-CoV-2 infection worldwide.”

—Sean R. Hosein

REFERENCE:

Sachdev D, Mara E, Hsu L, et al. COVID-19 susceptibility and outcomes among people living with HIV in San Francisco. JAIDS. 2020; in press.