People with HIV should be given priority with COVID-19 vaccination due to the higher risk, the WHO recommends


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Global study found people living with HIV were at higher risk of severe COVID-19 and death from COVID-19

People living with HIV should have COVID-19 vaccination priority, the World Health Organization said last week after research showing people with HIV were at increased risk at the Eleventh AIDS Society International Conference on HIV Science Being hospitalized with severe COVID-19 and dying of COVID-19.

A study conducted by the World Health Organization of over 15,000 cases of COVID-19 in people with HIV found that:

  • People living with HIV were 13% more likely to be hospitalized with severe or critical COVID-19 after monitoring for age, gender, and comorbidities.
  • They were more likely to die after being hospitalized with COVID-19; People with HIV had a 30% increased risk of death, regardless of age, gender, severity at presentation, and comorbidities.
  • In people with HIV, diabetes, high blood pressure, male, or over the age of 75 were each associated with an increased risk of death.

While the increase in the risk of severe COVID-19 is modest, it is particularly important in countries like South Africa where the number of people living with HIV is large, said Dr. Silvia Bertagnolio from the WHO told aidsmap. “This becomes important in overburdened health systems, where people with HIV may have more severe illnesses and need more health resources.”

glossary

diabetes

A group of diseases characterized by high blood sugar (glucose) levels. Type 1 diabetes occurs when the body doesn’t make insulin, a hormone that regulates blood sugar. Type 2 diabetes occurs when the body either does not make enough insulin or does not use insulin normally (insulin resistance). Common symptoms of diabetes include frequent urination, unusual thirst, and extreme hunger. Some antiretroviral drugs can increase your risk of type 2 diabetes.

hypertension

When the blood pressure (the force of the blood pushing against the arteries) is constantly too high. Increases the risk of heart disease, stroke, kidney failure, cognitive impairment, visual impairment and erectile dysfunction.

high blood pressure

When the blood pressure (the force of the blood pushing against the arteries) is constantly too high. Increases the risk of heart disease, stroke, kidney failure, cognitive impairment, visual impairment and erectile dysfunction.

Comorbidity

The presence of one or more additional health conditions at the same time as a primary disease (e.g. HIV).

Odds ratio (OR)

Comparing one group to another expresses the differences in the likelihood of something happening. An odds ratio above 1 means that something is more likely to happen in the group of interest; An odds ratio below 1 means that this is less likely. Similar to “relative risk”.

The WHO has been researching the risks of COVID-19 in people living with HIV, as previous studies have shown conflicting results.

Study of the WHO global clinical platform

The World Health Organization’s Global Clinical Platform for COVID-19 has collected individual patient records from 268,412 people who have been hospitalized since the beginning of the COVID-19 pandemic. Anonymized patient data was submitted to the platform from national registries and sentinel health institutions in 37 countries.

To study the effects of HIV on the consequences of COVID-19, Dr. Bertagnolio and WHO colleagues result data for 15,522 people living with HIV, from 24 countries, submitted by April 29, 2021. The vast majority (94.6%) of these cases were reported from South Africa.

The researchers looked at two outcomes in people living with HIV compared to the rest of the population: inpatient mortality and the severity of the disease on admission to hospital.

Cases were defined as severe if, upon ingestion, they met one or more of the following criteria: an oxygen saturation level of 90% or less; a breathing rate greater than 30 breaths per minute in adults and children over the age of five; Using an artificial lung (ECMO) for oxygen supply; Treatment with an inotropic agent or vasopressor (used in intensive care settings to treat shock or heart problems); Oxygen therapy or ventilation; Treatment in an intensive care unit. Cases that did not meet these criteria were classified as mild or moderate.

People with HIV who were hospitalized with COVID-19 were predominantly female (63%) and relatively young (49% were 18-45 years old and 41% were 45-65 years old). One third had high blood pressure, 22% diabetes, 16% obesity, 13% tuberculosis, 12% chronic kidney disease, and 12% chronic liver disease.

Just over a third of people hospitalized with HIV (5,563) had severe or critical COVID-19. Of these, 35% died. Of those with mild or moderate disease on admission, 17% died.

Looking at all COVID-19 cases reported to the Global Platform, the WHO found that people with HIV were at higher risk of developing severe or critical illness at admission after adjusting their age, gender and the presence of underlying diseases (adjusted Odds Ratio 1.06.). , 95% confidence interval 1.02-1.11). The risk appeared to be greater when cases from South Africa were excluded, so 425 cases with severity data were available (adjusted odds ratio 2.27, 95% CI 1.73-2.97).

Older age, diabetes, and high blood pressure all increased the risk of admission with serious illness in people with HIV.

People with HIV also had a higher risk of death after hospitalization with COVID-19 (adjusted hazard ratio 1.29, 95% CI 1.23-1.35) after adjusting for age, gender, disease severity, and underlying diseases.

As with serious illness, age, diabetes, and high blood pressure increased the risk of hospitalized death in people with HIV after being admitted to COVID-19. Age and diabetes had a greater influence on the risk of death than men or high blood pressure (aHR 1.82, [95% CI 1.62-2.04] and 1.50 (95% CI 1.39-1.62), respectively.

When analyzing the risk of mortality by WHO region, HIV remained an independent risk factor for death after hospitalization in the WHO African region (aHR 1.29, 95% CI 1.23-1.34), but not in the WHO Europe region (aHR 0.59, 95% CI.). 0.29-1.2 or the WHO region America (aHR 0.92, 95% CI 0.37-2.31) Due to the low number of cases compared to the African region, the confidence intervals for these regions are large.

The data on people living with HIV submitted to the platform did not contain information about CD4 counts and viral load, so it could not be determined whether these factors influenced the results in people with HIV. Information on antiretroviral treatment was only available for 40% of the submitted cases.

Impact on vaccination policy

The World Health Organization recommended last week that vaccination should be given to people with HIV. A WHO quick survey of 100 countries found that 40 have already prioritized people with HIV, including India, Indonesia, and many countries in Latin America and North America. But prioritization is only half the equation – countries need access to vaccine supplies too.

“There is a critical need for vaccine equity; in low and middle income countries we only have 3-4% vaccination protection and we have to give everyone the first dose, ”said Dr. Meg Doherty, director of WHO’s global HIV, hepatitis and STI programs, at a press conference.

The President of the International AIDS Society, Professor Dr. Adeeba Kamarulzaman commented, “We hope to use IAS 2021 to mobilize the medical community [on vaccination for people with HIV] just as the Durban Conference in 2000 led the HIV community to ensure that antiretroviral therapy reaches people in low-income countries. It took us five years to get there […] so let’s not repeat this mistake. “

Dr. Doherty also stressed the importance of stepping up testing activities. “We have at least ten million people who don’t know their HIV status – we need to make sure that people are tested.”

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