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“H.I.V. knocks out all the brakes on the immune system, and as a consequence you get this inflammatory response that’s robust and sustained — and now you got Covid on top of that,” said Dr. Steven Deeks, an H.I.V. expert at the University of California, San Francisco. “I would be surprised if H.I.V. was not associated with progression” of Covid-19.
Dr. Deeks disagreed with the study researchers’ decision to adjust the calculations for the presence of other conditions such as obesity because H.I.V. infection itself can cause many of those illnesses. “For 25 years, we’ve been arguing that a history of H.I.V. infection is an independent risk factor of progressing to heart disease, cancer, aging,” he said. Without that statistical adjustment, he said, the increased risk of death for these patients would have most likely been higher than the 30 percent reported by the study.
Many earlier studies had a bias that might have masked some of the risk: Doctors are more likely to admit Covid-19 patients with H.I.V. to the hospital, out of an abundance of caution, leading to patients who are less sick, and more likely to survive, compared with those who do not have H.I.V. That larger pool of patients would make H.I.V. infection appear to be less of a problem than it is, said Dr. Matthew Spinelli, an infectious disease physician at San Francisco General Hospital.
“Early studies may have led people down the wrong track on this question,” he said. The new study’s findings are more in line with large, population-based studies from South Africa and England showing that H.I.V. infection doubles the risk of dying from Covid-19, and from a similar study in New York State, he added.
The new findings should prompt doctors to provide people with H.I.V. swift access to monoclonal antibodies or antiviral drugs to treat Covid-19, Dr. Deeks said. The data also underscores the need to understand how H.I.V. infection affects a person’s response to a Covid vaccine, and whether some people with H.I.V. need boosters as many immunocompromised people do.
AIDS activists successfully fought for inclusion of people with H.I.V. in clinical trials of coronavirus vaccines, but the data is limited. A clinical trial in South Africa showed higher efficacy for the coronavirus vaccine made by Novavax when the analysis excluded people with H.I.V., suggesting that H.I.V. infection undermines the immune response to vaccines.
Out of 100 countries that have released information, 40 have listed people living with H.I.V. as a priority group for Covid-19 vaccination, said Dr. Meg Doherty, who directs H.I.V. programs at the W.H.O.
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