Almost 2 years into the SARS-CoV-2 pandemic, many people are starting to enjoy freedoms afforded by relaxation of restrictions. Governments are interpreting vaccine roll-out to mean that the catastrophic waves of COVID-19 that have shut down societies are a thing of the past. At the same time, evidence of the interaction between SARS-CoV-2 and HIV is also growing, and the better understanding of clinical outcomes is providing clarity on clinical management and measures needed to protect people with HIV. However, emerging evidence implicates immunosuppression and uncontrolled HIV infection in the generation of new SARS-CoV-2 variants.
Two papers in this issue provide substantial additions to the evidence on clinical outcomes of COVID-19 in people with HIV. Yang and colleagues describe data from the US National COVID Cohort Collaboration, including 1 436 622 adults with COVID-19, of whom 13 170 have HIV. People with HIV had higher odds of COVID-19 death and hospitalisation than did people without HIV. Older age groups and male, Black or African American, and Hispanic or Latinx adults were most at risk. CD4 counts lower than 200 cells per μL were associated with adverse COVID-19 outcomes. Nomah and colleagues describe 749 COVID-19 cases in a Spanish cohort of 13 142 people with HIV: old age, non-Spanish origin, and neuropsychiatric illness, autoimmune disease, respiratory disease, and metabolic disease increased risks of severe outcomes.
In a Comment linked to the two papers, Boffito and Waters say the studies “add to the accumulating evidence for worse outcomes for people with HIV and support early guidance that people with HIV, particularly those with immune suppression, should be prioritised for COVID-19 risk reduction, including vaccination”. We agree with the conclusion that there is an urgent need for vaccination against SARS-CoV-2 for all people with HIV globally.
As numerous countries begin booster programmes, global disparities in vaccine coverage grow starker. Although there is a strong argument for additional doses for immunocompromised or otherwise vulnerable individuals, the scientific basis for boosting in the general population is poor. The case for ensuring high coverage of vaccines worldwide is irrefutable.
There is an urgent case to ensure that people living with HIV around the world are prioritised for SARS-CoV-2 vaccination. First and foremost to save lives and prevent illness among this clinically vulnerable populations. But vaccination might also block a potential wellspring of variants that could jeopardise the global COVID-19 response. Moreover, the lesson for the global COVID-19 recovery is clear: treatment of HIV must be prioritised to save lives now and to help protect everyone in the event of future pandemics.
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