HANC formed the COVID-19 CAB Coalition in September 2020 to share information, facilitate resource sharing and advocate on the behalf of the overall COVID-19 research efforts.
HANC, together with the COVID-19 CAB Coalition, maintains and updates this page focused on information about the COVID-19 pandemic and its intersection with the HIV pandemic.
Coronavirus disease 2019 (COVID-19) is the infectious disease caused by the most recently discovered coronavirus. This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019. The new virus that causes COVID-19 illness has been named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
The most common symptoms of COVID-19 are fever, tiredness, and dry cough. Some patients may have aches and pains, nasal congestion, runny nose, sore throat or diarrhea. These symptoms are usually mild and begin gradually. Some people become infected but don’t develop any symptoms and don't feel unwell. Most people (about 80%) recover from the disease without needing special treatment. Around 1 out of every 6 people who gets COVID-19 becomes seriously ill and develops difficulty breathing. Older people, and those with underlying medical problems like high blood pressure, heart problems or diabetes, are more likely to develop serious illness. People with fever, cough and difficulty breathing should seek medical attention.
Coronaviruses are a large family of viruses that usually cause mild to moderate upper-respiratory tract illnesses, like the common cold, in people. However, three times in the 21st century coronavirus outbreaks have emerged from animal reservoirs to cause severe disease and global transmission concerns.
There are hundreds of coronaviruses, most of which circulate among animals including pigs, camels, bats and cats. Sometimes those viruses jump to humans—called a spillover event—and can cause disease. Seven coronaviruses are known to cause human disease, four of which are mild: viruses 229E, OC43, NL63 and HKU1. Three of the coronaviruses can have more serious outcomes in people, and those diseases are SARS (severe acute respiratory syndrome) which emerged in late 2002 and disappeared by 2004; MERS (Middle East respiratory syndrome), which emerged in 2012 and remains in circulation in camels; and COVID-19, which emerged in December 2019 from China and a global effort is under way to contain its spread. COVID-19 is caused by the coronavirus known as SARS-CoV-2.
Thanks to research investments into the SARS and MERS outbreaks, NIAID scientists and grantees are better prepared to develop diagnostics, therapeutics and vaccines against COVID-19. Included in those projects are basic research to understand how the virus infects cells and causes disease; adapting platforms used to develop diagnostic tests and vaccines; and evaluating treatments such as broad-spectrum antivirals and potentially monoclonal antibodies.
Note: COVID-19 is an emerging, rapidly evolving situation.
Access the latest public health information from the CDC and explore frequently asked questions, including COVID-19: What people with HIV should know.
As the pandemic has evolved, so have NIH’s response and strategies. Learn more about the latest research, testing, treatments & vaccines and how to participate in clinical trials.
View the latest in public advice and technical guidance from the World Health Organization. The public site also features a global research database with literature dedicated to the coronavirus disease.
Interim Guidance for COVID-19 and Persons with HIV
This interim guidance reviews special considerations for persons with HIV and their health care providers in the United States regarding COVID-19. Information and data on COVID-19 are rapidly evolving. This guidance includes general information to consider. People with HIV who have COVID-19 have an excellent prognosis, and they should be clinically managed the same as persons in the general population with COVID-19, including when making medical care triage determinations.
This interim guidance was prepared by the following working groups of the Office of AIDS Research Advisory Council:
Clinicians should refer to updated sources for more specific recommendations regarding COVID-19.
(Last Updated: February 26, 2021)
The NIH HIV/AIDS Clinical Trials Networks (ACTG, HPTN, HVTN, IMPAACT and MTN) have all issued guidance on the status of new and ongoing studies, viewable in the HIV/AIDS Clinical Trials Network Response to COVID-19 section on this page. Contact your site or network if you have questions about specific ongoing studies. Find additional guidance specific to laboratories in the Laboratory Resources section on this page.
Guidance on the Management of Clinical Trials during the COVID 19 (Coronavirus) Pandemic
The European Medicines Agency (EMA) and collaborators have prepared a document that sets out to include most of the current guidance across Member States with the aim of serving as a harmonised EU-level set of recommendations to mitigate and slow down the disruption of clinical research in Europe during the public health crisis.
Conduct of Clinical Trials of Medical Products during the COVID-19 Pandemic
The FDA has issued this guidance to provide general considerations to assist sponsors in assuring the safety of trial participants, maintaining compliance with good clinical practice (GCP), and minimizing risks to trial integrity for the duration of the COVID-19 public health emergency.
(Last updated: January 27, 2021)
Guidance for NIH-funded Clinical Trials and Human Subjects Studies Affected by COVID-19 (Notice Number: NOT-OD-20-87)
This notice provide guidance outlining the flexibilities available to recipients conducting NIH-funded clinical trials and human subject studies that are impacted by the declared public health emergency for COVID-19.
Flexibilities Available to Applicants and Recipients of Federal Financial Assistance Affected by COVID-19 (Notice Number: NOT-OD-20-86)
The purpose of this notice is to alert the community of administrative flexibilities that will apply to NIH applicants and recipients. These flexibilities are applicable to NIH applicants and recipients where the entity is conducting research activities related to or affected by COVID-19.
NCI Interim Guidance for Patients on Clinical Trials
Due to concerns regarding the spread of the novel coronavirus and the impact it is having on hospitals, clinics, physician offices, and patients’ ability to travel, the NCI Cancer Therapy Evaluation Program (CTEP) and the NCI Community Oncology Research Program (NCORP) have provided clarification on measures to address some of the current challenges in providing care to patients enrolled on clinical trials in order to mitigate any immediate hazards.
(Issued March 13, 2020)
SAHPRA Policy on Conduct of Clinical Trials of Health Products During the Current Covid-19 Pandemic
The South African Health Products Regulatory Authority (SAHPRA) is committed to providing timely health products regulatory guidance in support of continuity for stakeholders and appropriate timely regulatory response during the current COVID-19 pandemic. Specifically, this communication provides assistance to sponsors and applicants including clinical research organizations (CROs) in assuring the safety of trial participants, maintaining compliance with current good clinical practice (GCP), and minimizing risks to trial integrity during the COVID-19 pandemic.
(Issued March 25, 2020)
Considerations & Suggested Practices for Ambulatory HIV Specialty Care During COVID-19 Pandemic
As part of the American Academy of HIV Medicine’s commitment to provide relevant and useful information during the COVID-19 pandemic, please find attached a Spanish translation of the newly released guidance on COVID-19 and HIV care.
COVID-19: Special Considerations for People with HIV
Created by the Infectious Disease Society of America (IDSA) and the HIV Medical Association (HIVMA), this document on COVID-19 considerations for people living with HIV (PLWH) is intended as a resource for clinicians and public health officials.
(Version: April 17, 2020)
COVID-19 Real-Time Learning Network
The Infectious Disease Society of the USA (IDSA) has curated library of COVID-19 clinical guidance, institutional protocols, clinical trials data, practice tools and resources from a variety of medical subspecialties around the world. The site is regularly updated as resources and new information become available.
British HIV Association Website
All BHIVA statements related to Coronavirus (COVID-19) and HIV are available on the BHIVA website. Statements include guidance on initiation of antiretroviral treatment (ART) during the coronavirus pandemic, HIV services, SARS-CoV-2 antibody testing for people living with HIV, vaccine advice for adults living with HIV, and additional FAQs and advice for people living with HIV.
HIV and COVID-19 Virtual Issue
This collection of papers explores emerging insights about the epidemiology and biology of SARS-CoV-2, as well as the social and structural factors potentiating spread and responses to contain the pandemic. Unique clinical features of SARS-CoV-2/HIV-1 co-infection are also discussed.
The Virtual Issue is continuously updated to include new articles as they are being published.
(Last updated: November 27, 2021)
HIV Treatment Bulletin - COVID-19 Special Issue
The March 27, 2020 edition of the HIV Treatment Bulletin (HTB) is on the global health crisis related to the new coronavirus (SARS CoV-2) and COVID-2019 and the effect it will have for people living with HIV.
HIV and COVID-19: i-Base articles and links
The i-Base COVID-19 page also includes new articles, Q&A posts, and non-technical links with information specific to people living with HIV.
No increased coronavirus risk for people with well-controlled HIV say WHO, but how will health systems cope?
Initial data from Wuhan, China, dating back to March 2020, suggested that people living with HIV suffered no worse a coronavirus epidemic than other people in the city, and confirmed the World Health Organization’s position that people with well-controlled HIV do not appear to be at elevated risk of coronavirus infection or severe disease. Nonetheless, the risk of disruption to HIV services is significant, especially as the new coronavirus spreads to countries with fragile health systems.
NAM has since released additional reporting on HIV programming during the COVID-19 pandemic and impacts on people with HIV.
POZ #Coronavirus
The POZ Coronavirus (COVID-19) page includes information about how the new coronavirus affects people living with HIV. Although older people, those with other health conditions and people with compromised immune systems remain most at risk of severe illness from the new coronavirus, everyone should be vigilant.
COVID-19 Comprehensive Resource Center
The Clinical Care Options (CCO) COVID-19 Comprehensive Resource Center hosts a repository of MedicalMinute Updates, Q&A webinars, and slide sets to communicate the latest data on COVID-19 epidemiology and clinical management, best practices, and ongoing research.
HIV and COVID-19: What Do We Know Now?
The MedicalMinute Update from December 10, 2020 discusses HIV and COVID-19: What Do We Know Now and reviews the relationship between HIV infection and COVID-19 outcomes.
Clinical Care Options HIV
More information specific to the intersection between SARS-CoV-2 and HIV, particularly among special populations such as aging patients with HIV infection or pregnant women with HIV, is found under the CCO HIV section.
Coronavirus (Covid-19): supporting global research and development
The Wellcome Trust is supporting COVID-19 research and development and working to make sure that any new vaccines, tests and treatments are mass-produced quickly and reach everyone who needs them.
Indian Country Resources: Coronavirus (COVID-19)
The National Congress of American Indians has developed a COVID-19 Resource Center.
Tribal Advocacy Materials for Implementing COVID-19 Funding
Presented here are the numerous letters NCAI and partner organizations have drafted and submitted to support tribal nations during the COVID-19 pandemic.
The HIV/AIDS Clinical Trials Networks have mobilized in response to the global pandemic and provided key support for COVID-19 vaccine and therapeutic research efforts. Studies and COVID-19 research collaborations in which the HIV/AIDS Clinical Trials Networks are involved are listed below.
The COVID-19 Prevention Network (CoVPN) was formed by the National Institute of Allergy and Infectious Diseases (NIAID) at the US National Institutes of Health to respond to the global pandemic. Using the infectious disease expertise of their existing research networks and global partners, NIAID has directed the networks to address the pressing need for vaccines and monoclonal antibodies (mAbs) against SARS-CoV-2.
The ACTIV-2 Outpatient Monoclonal Antibodies and Other Therapies Trial is a master protocol to evaluate the safety and efficacy of investigational agents for the treatment of symptomatic non-hospitalized adults with COVID-19. It begins with a phase II evaluation, followed by a transition into a larger phase III evaluation for promising agents.
Why is this study being done?
To rapidly and efficiently evaluate multiple potential therapeutics for COVID-19 in an outpatient setting.
Who can join?
Duration of study: 28 days of intensive follow-up, followed by limited follow-up through 24 weeks.
The NIH-funded HIV Vaccine Trials Network (HVTN) and HIV Prevention Trials Network (HPTN) have initiated their first clinical trial in response to COVID-19. The study, called HVTN 405/HPTN 1901, is underway at clinical trial sites across North and South America and will describe immune responses in study participants with a history of infection with SARS-CoV-2, the virus that causes COVID-19. HVTN 405/HPTN 1901 aims to enroll approximately 400 study participants aged 18 and older who tested positive for SARS-CoV-2 and have since recovered. Participants will have one required clinic visit and will have the option to participate in additional clinic visits two, four and twelve months after the initial visit. Each visit includes a blood draw and optional nasal sampling procedures. Individuals who still have symptoms of infection or asymptomatic individuals less than two weeks from the date of their last positive test will not be enrolled.
Leveraging the infectious disease expertise, research infrastructure, and community partnerships of the existing HIV/AIDS research networks, the networks have responded to the need for vaccines, monoclonal antibodies, and therapeutics against SARS-CoV-2 infection. Announcements and public communications from the networks are found below:
HVTN COVID-19 Response Webpage
HVTN Public Statement on COVID-19 (1/2, dated March 2020) (Website | PDF)
HVTN Public Statement on COVID-19 (2/2, dated April 1, 2020) (Website | PDF)
DAIDS HIV/AIDS Network Guidance for COVID-19 Pandemic (dated March 13, 2020)
DAIDS Memo: Suspension of On-Site Monitoring Visits (dated March 19, 2020)
DAIDS Memo: Extended Suspension of On-Site Monitoring Visits (dated April 06, 2020)
DAIDS Memo: OHRP Guidance on COVID-19 (dated April 10, 2020)
DAIDS Memo: Phased Approach to Resumption of On-Site Monitoring Visits (dated May 11, 2020)
The SIDP have prepared brief, evidence-based educational reviews of potential pharmacotherapeutic treatment options for COVID‑19. Video presentations and handouts are updated regularly.
The Milken Institute is currently tracking the development of treatments and vaccines for COVID‑19. This tracker contains an aggregation of publicly-available information from validated sources.
The LDIG has produced prescribing resources and other materials to assess drug interactions with experimental agents used in the treatment of COVID‑19
Emergency Use Authorization (EUA)
A record of vaccines, drug and biological therapeutic products, and medical devices authorized by the FDA under Emergency Use Authorization (EUA) can be found on the FDA website. The EUA authority allows FDA to help strengthen the nation’s public health protections against chemical, biological, radiological, and nuclear (CBRN) threats including infectious diseases, by facilitating the availability and use of medical countermeasures (MCMs) needed during public health emergencies. Background information about EUAs and records of authorizations issued by the FDA
The EUA is not intended to replace randomized clinical trials and facilitating the enrollment of patients into any of the ongoing randomized clinical trials is critically important for the definitive demonstration of safety and efficacy of COVID-19 vaccines and therapeutics.
Treatments and Vaccines for COVID-19
A compliation of medicines authorised in the European Union (EU) to treat or prevent COVID-19, following a scientific evaluation by the European Medicines Agency (EMA). Additional details are provided on other potential treatments and vaccines that the EMA is evaluating or has provided support to during research and development.
COVID-19 Outcomes Among Persons Living With or Without Diagnosed HIV Infection in New York State
Tesoriero JM et al., February 1, 2021 - JAMA Network Open
Key Takeaway: In this cohort study, persons living with diagnosed HIV experienced poorer COVID-related outcomes relative to persons living without diagnosed HIV; Previous HIV diagnosis was associated with higher rates of severe disease requiring hospitalization, and hospitalization risk increased with progression of HIV disease stage.
The interplay between HIV and COVID-19: summary of the data and responses to date
Brown LB et al., November 11, 2020 - Curr Opin HIV AIDS
Key Takeaway: Evidence to date does not suggest that people living with HIV (PLWH) have a markedly higher susceptibility to SARS-CoV-2 infection, with disparities in the social determinants of health and comorbidities likely having a greater influence. The majority of literature has not supported a higher risk for severe disease among PLWH in Europe and the United States, although a large, population-based study in South Africa reported a higher rate of death due to COVID-19. Higher rates of comorbidities associated with COVID-19 disease severity among PLWH is an urgent concern. COVID-19 is leading to decreased access to HIV prevention services and HIV testing, and worsening HIV treatment access and virologic suppression, which could lead to worsening HIV epidemic control. COVID-19 is threatening gains against the HIV epidemic, including the U.S. Ending the HIV Epidemic goals. The ongoing collision of these two global pandemics will continue to need both study and interventions to mitigate the effects of COVID-19 on HIV efforts worldwide.
The first 6 months of HIV-SARS-CoV-2 coinfection: outcomes for 6947 individuals
Johnston R, November 5, 2020 - Curr Opin HIV AIDS
Key Takeaway: The current review considers 6 months of data across geographic regions with a range of healthcare quality and access and ART regimens to generate a wider view of COVID-19 outcomes in PWH. Taken together, these studies indicate that HIV infection may be associated with increased risk of COVID-19 diagnosis, but comorbidities appear to play a larger role than HIV-specific variables in outcomes of COVID-19 among PWH. ART does not appear to protect from COVID-19 disease acquisition, progression or death.
Characteristics and outcomes of COVID-19 in patients with HIV: a multicentre research network study
Hadi YB et al., November 01, 2020 - AIDS
Key Takeaway: The authors studied clinical outcomes of COVID-19 infection in patients living with HIV (PLH) in comparison to non-HIV population. Crude COVID-19 mortality is higher in people living with HIV; however, propensity-matched analyses revealed no difference in outcomes, showing that higher mortality is driven by higher burden of comorbidities. Early diagnosis and intensive surveillance are needed to prevent a ‘Syndemic’ of diseases in this vulnerable cohort.
HIV infection and COVID-19 death: population-based cohort analysis of UK primary care data and linked national death registrations within the OpenSAFELY platform
Bhaskaran K et al., December 11, 2020 - Lancet HIV
Key Takeaway: We used UK primary care data from more than 17 million people linked to national death registrations to compare risk of COVID-19 death between people with and without HIV. People with HIV were at elevated risk of COVID-19 mortality compared with the general population without HIV, even after accounting for demographic characteristics, lifestyle-associated factors, and comorbidities. The association was particularly marked among people of Black ethnicity.
Outcomes of COVID-19 related hospitalisation among people with HIV in the ISARIC WHO clinical characterisation protocol UK protocol: prospective observational study
Geretti AM et al., August 11, 2020 - Clin Infect Dis
Key Takeaway: The authors compared the presentation characteristics and outcomes of people with and without HIV hospitalised with COVID-19 at 207 centres across the United Kingdom. The cumulative incidence of day-28 mortality was 25.2% in the HIV-positive group versus 32.1% in the HIV-negative group (p=0.12); however, stratification for age revealed a higher mortality among HIV-positive people aged below 60 years. The effect of HIV-positive status was confirmed in adjusted analyses (adjusted HR 1.49, 95% CI 0.99-2.25; p=0.06). Following additional adjustment for disease severity at presentation, mortality was higher in HIV-positive people (adjusted HR 1.63; 95% CI 1.07-2.48; p=0.02). In the HIV-positive group, mortality was more common among those who were slightly older and among people with obesity and diabetes with complications. The authors concluded that HIV-positive status may be associated with an increased risk of day-28 mortality following a COVID-19 related hospitalisation.
Immunologic characteristics of acute COVID-19 in people with HIV
Ho H et al., July, 2020 - 23rd International AIDS Conference, Abstract OABLB0104
Key Takeaway: "A related study showed that people with HIV had higher levels of inflammation, indicating that they are capable of mounting a strong inflammatory response to the new coronavirus and remain at risk for severe COVID-19 despite taking antiretroviral therapy (ART)."
Read Full Coverage by Liz Highleyman, NAM AIDSMAP
Clinical outcomes by HIV serostatus, CD4 count, and viral suppression among people hospitalized with COVID-19 in the Bronx, New York
Patel VV et al., July, 2020 - 23rd International AIDS Conference, Abstract OABLB0102
Key Takeaway: "People living with HIV spent a similar amount of time in hospital as HIV-negative COVID-19 patients and had a comparable death rate during the height of the outbreak in New York City, but they were more likely to be put on ventilators."
Read Full Coverage by Liz Highleyman, NAM AIDSMAP
COVID-19 in the largest US HIV cohort
Park LS et al., July, 2020 - 23rd International AIDS Conference, Abstract LBPEC23
Key Takeaway: "An analysis of the largest cohort of people living with HIV in the United States found that they were not more likely to contract the new coronavirus, and those who did so were not more likely to develop severe COVID-19."
Read Full Coverage by Liz Highleyman, NAM AIDSMAP
Incidence and Severity of COVID-19 in HIV-Positive Persons Receiving Antiretroviral Therapy
Del Amo J et al., June 26, 2020 - Annals of Internal Medicine
Key Takeaway: "HIV-positive patients receiving TDF/FTC have a lower risk for COVID-19 and related hospitalization than those receiving other therapies. These findings warrant further investigation in HIV preexposure prophylaxis studies and randomized trials in persons without HIV.”
Description of COVID-19 in HIV-infected individuals: a single-centre, prospective cohort
Vizcarra P et al., August 2020 - Lancet HIV
Key Takeaway: “HIV-infected individuals should not be considered to be protected from SARS-CoV-2 infection or to have lower risk of severe disease. Generally, they should receive the same treatment approach applied to the general population.”
Hospitalized patients with COVID-19 and HIV: a case series
Childs K et al., May 27, 2020 - Clin Infect Dis, online ahead of print
Key Takeaway: "Compared to our whole HIV outpatient cohort, those hospitalized with COVID-19 were more likely to be of black ethnicity (OR, 12.22 [95% CI, 1.62–92.00]) and to have lower median CD4 cell counts (395 vs 573, P = .03) (Supplementary Table 1). There was a trend toward more common use of protease inhibitor–containing antiretroviral regimens among those with COVID-19 (OR, 2.43 [95% CI, .94–6.29]). Our data indicate that, in contrast to earlier reports, there may be substantial morbidity and mortality from COVID-19 among PWH, even among those on suppressive ART. Black PWH appear to be at substantially increased risk of severe disease, and darunavir (or any other class of ART) does not appear to provide protection against moderate/severe COVID-19. If confirmed, African regions with a high prevalence of HIV infection.”
COVID-19 in Persons Living with HIV — What Do We Know Today?
Del Rio C, August 11, 2020 - NEJM Journal Watch
Key Takeaway: A review of eight published studies suggests the risk of SARS-CoV-2 infection and severe COVID-19 disease for persons with HIV is not due to immunosuppression but mostly due to underlying socioeconomic conditions and comorbidities. However, none of these studies came from Africa, where the largest percentage of people with HIV live. A preprint (not peer-reviewed) publication from the Western Cape in South Africa suggests that HIV increases the risk for COVID-19 mortality. The cohort study included close to 3.5 million people (16% HIV-positive) who live in the Western Cape, of whom 22,308 were diagnosed with COVID-19 and 625 (2.8%) died. HIV doubled the risk for COVID-19 mortality regardless of viral suppression. Current or previous tuberculosis also increased COVID-19 mortality.
COVID-19 in patients with HIV: clinical case series
Blanco JL et al., April 15, 2020 - Lancet HIV
Key Takeaway: Patients with HIV accounted for almost 1% of patients with COVID-19 who required admission to hospital in Barcelona. Infection was only observed in people younger than 50 years, who identified as MSM, and who have a COVID-19 clinical pictures resembling the general population. More studies of COVID-19 in patients with HIV are needed in the older MSM population, drug users, and heterosexual men and women in middle-income and lower-income settings. Second, implementing health education programmes is very important to explain that sex work-related activities in congregate settings could cause clusters of SARS-CoV-2 transmission. Third, investigation into the efficacy of ART regimens based on protease inhibitors in patients with COVID-19 in combined therapy in earlier stages of the disease is needed. Fourth, we did not give our patients remdesivir, the most active in-vitro and in-vivo antiviral drug against coronavirus to date, and is currently only available through clinical trials or for compassionate use. Finally, in advanced patients, we must ensure differential diagnosis and initial antimicrobial treatment to address pulmonary opportunistic infections presenting with similar clinical and radiological symptoms. By generating information such as we present here, the management and prognosis of patients co-infected with HIV and SARS-CoV-2 might be improved.
Lancet HIV 2021 Oct 13;S2352-3018(21)
The authors of this comment concerns these two studies published in Lancet HIV:
In The Lancet HIV two Articles by Daniel K Nomah and colleagues and Xueying Yang and colleagues provide additional information on COVID-19 outcomes among people with HIV. Nomah and colleagues describe 749 COVID-19 cases in a Spanish cohort of 13,142 people with HIV, although the absence of data on people without HIV means conclusions about the relative mortality risk of HIV cannot be drawn. Yang and colleagues describe the effect of HIV on adverse COVID-19 outcomes from an analysis of the National COVID Cohort Collaborative (N3C) data in the USA. Of the 1,436,622 adult COVID-19 cases, 13 170 were in people living with HIV and of the 26 130 COVID-19 related deaths, 445 were in people living with HIV. HIV was associated with a 20% higher risk of hospitalization, and a 29% higher risk of COVID-19 mortality after adjustment for different covariates.
They note in summary: Since COVID-19 emerged as serious threat to health globally, providing accurate advice to people with HIV, and their health-care providers, has been challenging. The studies from Nomah and colleagues and Yang and colleagues, 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 prioritized for COVID-19 risk reduction, including vaccination. These studies also shine more light on the stark and harsh reality of the health inequities that have been magnified by COVID-19. Although the current inequalities in global COVID-19 vaccine coverage are a gross injustice, it will take more than a vaccine to address the socioeconomic disparities, structural racism, and political inaction that render the most vulnerable in society at greatest risk of harm.
Associations between HIV infection and clinical spectrum of COVID-19: a population level analysis based on US National COVID Cohort Collaborative (N3C) data
Lancet HIV 2021 Oct 13;S2352-3018(21)
Findings: In the harmonized N3C data release set from Jan 1, 2020, to May 8, 2021, there were 1,436,622 adult COVID-19 cases, of these, 13,170 individuals had HIV infection. A total of 26,130 COVID-19 related deaths occurred, with 445 among people with HIV. After adjusting for all the covariates, people with HIV had higher odds of COVID-19 death (adjusted odds ratio 1·29, 95% CI 1·16-1·44) and hospitalization (1·20, 1·15-1·26), but lower odds of mild or moderate COVID-19 (0·61, 0·59-0·64) than people without HIV. Interaction terms revealed that the elevated odds were higher among older age groups, male, Black, African American, Hispanic, or Latinx adults. A lower CD4 cell count (<200 cells per μL) was associated with all the adverse COVID-19 outcomes, while viral suppression was only associated with reduced hospitalization.
Interpretation: Given the COVID-19 pandemic's exacerbating effects on health inequities, public health and clinical communities must strengthen services and support to prevent aggravated COVID-19 outcomes among people with HIV, particularly for those with pronounced immunodeficiency.
Sociodemographic, clinical, and immunological factors associated with SARS-CoV-2 diagnosis and severe COVID-19 outcomes in people living with HIV: a retrospective cohort study
www.thelancet.com/hiv Published online October 13, 2021 https://doi.org/10.1016/S2352-3018(21)
This was a retrospective cohort study using data from the PISCIS cohort of people with HIV in Catalonia (Spain) between March 1 and Dec 15, 2020. We linked PISCIS data with integrated health-care, clinical, and surveillance registries through the Public Data Analysis for Health Research and Innovation Program of Catalonia (PADRIS) to obtain data on SARS-CoV-2 diagnosis, chronic comorbidities, as well as clinical and mortality outcomes. Participants were aged at least 16 years in care at 16 hospitals in Catalonia.
The authors note: In this observational cohort study, we investigated SARS-CoV-2 diagnosis and severe outcomes in a cohort of people with HIV. To the best of our knowledge, this study of 749 people with HIV with SARS-CoV-2 co-infection is the largest in Europe. 103 (13·8%) co-infected patients were hospitalised and 13 (1·7%) died. All SARS-CoV-2 diagnoses were laboratory confirmed. SARS-Cov-2 diagnoses were increased among migrants, men who have sex with men (MSM), and those with four or more comorbidities. Being aged 75 years or older,
of non-Spanish origin, with chronic comorbidities, and detectable HIV viraemia were associated with severe COVID-19. People living with HIV with detectable HIV viraemia, chronic comorbidities, and some subpopulations could be at increased risk of severe outcomes from COVID-19. These groups should be prioritised in clinical management and SARS-CoV-2 vaccination programmes.
Clinical Infectious Diseases 2021;73(7):e2005–15
Results: Among nearly 3.5 million adults (16% PLWH) in South Africa, we found an approximately 2-fold association of COVID-19 death with HIV, irrespective of viremia or immunosuppression prior to the COVID-19 episode, and a similar association between COVID-19 death and current tuberculosis. Among PLWH on ART, receiving TDF was associated with lower COVID-19 mortality, compared to receipt of other antiretrovirals. While the HIV- and tuberculosis-associated increased risks of COVID-19 death may be overestimated if there is residual confounding, due to socioeconomic status or unrecorded comorbidities, our results, supported by sensitivity analyses, demonstrate that PLWH and persons with tuberculosis are at increased risk of severe COVID-19. Nonetheless, despite a high burden of advanced HIV in the province, the attributable fraction of all deaths ascribed to HIV was <10%.
In this study the authors conclude: While our findings of increased COVID-19 mortality risks in those living with HIV or tuberculosis may overestimate associations of these conditions with COVID-19 death due to residual confounding, PLWH and/or those with tuberculosis should nonetheless be considered high-risk groups for COVID-19 management, especially if they have other comorbidities.
COVID-19 Cases & Hospitalizations in a US Multisite Cohort Of People With HIV
CROI 2021 Abstract 543. Shapiro AE, Bender Ignacio RA, Whitney BM et al.
This study examined all PWH with SARS-CoV-2 infection and COVID-19 disease identified from laboratory testing data (RT-PCR, antigen test results) and ICD-10 codes March-July 2020 from seven sites in the CFAR Network of Integrated Clinical Systems (CNICS) cohort. Cases were verified by medical record review. We evaluated predictors of increased disease severity, indicated by hospitalization. Relative risks were estimated using Poisson regression, adjusted for clinical and demographic characteristics using disease risk scores.
Among 13,862 PWH in care (20% female, median age 52 (IQR 40-59), 58% Black or Hispanic race/ethnicity), 198 COVID-19 cases were detected during the study period. A higher proportion of PWH with COVID-19 were female (27%), Black or Hispanic (76%), and had BMI ?30 (45%). No significant differences in CD4+ count (current or lowest) were seen between PWH with and without COVID-19. We found evidence suggesting more unstable housing among COVID-19 cases compared to non-cases (14% vs. 9%). Among PWH with COVID-19, 38 (19%) were hospitalized, 10 (5%) required intensive care, 8 (4%) received invasive mechanical ventilation, and 4 (2%) died. Hospitalization among PWH with COVID-19 was associated with: CD4+ count ?350 (aRR 1.77; 95% CI 1.05, 2.98); age ?60 (aRR 2.0; 95%CI 1.13, 3.54); pre-existing kidney disease with eGFR <60 (aRR 1.76; 95% CI 0.99, 3.13); and BMI ?30 (aRR 1.96; 95% CI 1.02, 3.78) (Table).
The population frequency of COVID-19 detected in PWH was 1.4%, likely an underestimate of the true frequency of SARS-CoV-2 infection and COVID-19 disease due to evolving testing availability and access over time. A higher proportion of PWH with COVID-19 were Black or Hispanic, in excess of the overrepresentation of people of color with HIV compared to the general population. PWH with decreased eGFR, low CD4+ count, and obesity had greater risk of more severe COVID-19 disease.
These results highlight disparities in risk of COVID-19 acquisition among PWH in the US and indicate additional vigilance in screening and monitoring of COVID-19 among PWH with these characteristics. The expected accrual of additional COVID-19 cases will allow more precise evaluation of the impact of comorbidities.
HIV and SARS-CoV-2 Co-Infection: What are the Risks?
Infect Drug Resist 2021 Sep 28;14:3991-4014.
Abstract: The dramatic increase of the global pandemic of SARS-CoV-2 infection represents a critical issue that needs to be investigated to evaluate the associated risk factors for acquisition and worse outcome. The interplay between immune activation and immune depression during SARS-CoV-2 infection is an intriguing topic that still needs to be clarified. The role of HIV in SARS-CoV-2 infection is not well defined. Chronic inflammation linked to HIV infection could be a driver for a worse prognosis in people living with HIV (PLWH). We explored the role of HIV as a risk factor for SARS-CoV-2 infection and severity and which factors contributed to a worse prognosis when HIV infection was present. PubMed/MEDLINE was searched for "COVID-19" or "SARS-CoV2" and "HIV" or "AIDS" and ("hospitalization" or "intensive care" or "mechanical ventilation" or "death" OR "mortality"), both in MeSH and as free text in all fields. Our review focused on 21 studies that enrolled at least 40 PLWH. In most studies, HIV infection did not represent a risk factor for SARS-CoV-2 infection. On the contrary, the risk of severe COVID-19 and hospitalization was higher in PLWH. Low CD4 cell count consistently emerged as a risk factor for severe COVID-19. Comorbidities, either in people with or without HIV diagnosis, played a key role, especially because of their early development in PLWH.
ACTG ACTIV-2 study: Rise Above COVID
COVID-19 Prevention Network (CoVPN)
AVAC COVID-19 Advocates Advisory Board (CAAB)
The mission of the CAAB is to strategically engage civil society and community representatives to ensure the ethical, inclusive, efficient, and accelerated advancement of research and development for urgently needed interventions to combat COVID-19, as well as global access to proven interventions, especially among historically vulnerable and disenfranchised populations, countries, and communities.
What is the ACTG ACTIV-2 CAB? (Video)
ACTIV-2 CAB Member: Rose James, Urban Indian Health Institute (Video)
ACTIV-2 CAB Member: Rose James, Urban Indian Health Institute (Video, extended version)
Stony Brook: Lo que necesitas saber sobre las vacunas contra el COVID-19 (Video)
CoVPN videos:
Maria del Rosario Leo (Video) What is the difference between monoclonal antibodies and the vaccines for COVID-19?
Raphael Gonzalez (Video) Why is COVID-19 affecting some communities more than others?
Ro Yoon (Video) Should monoclonal antibody therapy be administered as soon as COVID-19 symptoms developed?
Robert Bucklew (Video)
Maria del Rosario Leo (Espanol) ¿Cuál es la diferencia entre los anticuerpos monoclonales y la vacuna para COVID-19?
Raphael Gonzalez (Espanol) ¿Por qué el COVID-19 afecta a algunas comunidades más que a otras?
The HANC-facilitated Behavioral Science Consultative Group (BSCG) developed a brief video on lessons from the HIV pandemic to guide COVID-19 responses. Link to video: Taking Cues: Lessons from the HIV Pandemic to Guide COVID-19 Responses
Since the COVID-19 pandemic began, researchers with existing longitudinal cohorts and survey samples have been developing and fielding new survey items assessing various COVID-19 specific domains such as symptoms, knowledge and attitudes, adherence to various mitigation behaviors, social impacts, and economic impacts. Efforts to standardize or harmonize COVID-19 survey items, however, did not appear feasible given the urgency to field items as early as possible during the pandemic.
To minimize the proliferation of one-off survey items, encourage comparisons across samples, and facilitate data integration and collaboration, a trans-NIH working group co-led by the National Institute on Aging (NIA) and the Office of Behavioral and Social Sciences Research (OBSSR) worked to make existing COVID-19 survey items and investigator contact information available in a survey item repository. Two NIH-supported survey item platforms have made this expanding list of survey items available as a resource for researchers interested in assessing COVID-19 specific domains.
Researchers addressing COVID-19 questions, whether population-based or for clinical research, are encouraged to consider these COVID-19 specific survey item repositories and select existing survey items or protocol modules currently being fielded. Researchers with additional survey items about to be fielded are encouraged to make them public for other researchers to consider by submitting the survey to NIHCOVID19Measures@nih.gov.
Provided by the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN). Revised April 8, 2020.
What is the goal of these questions?
A group of researchers from Nemours, CHOP and Cincinnati have developed a questionnaire designed for insertion into ongoing and new child health studies where aspects of the COVID-19 pandemic may impact study findings. The COVID-19 Exposure and Family Impact Survey (CEFIS-19) is in English and Spanish. There are also have REDCap versions. While designed for research, there may also be clinical applications. There is no charge for use, but it is requested that you register your work as the survey is covered by the SAMHSA-funded Center for Pediatric Traumatic Stress in the National Child Traumatic Stress Network. The Healthcare Toolbox has related COVID-19 materials that are updated and, in some cases, newly developed.
Shared by Anne E. Kazak, Ph.D., ABPP, Director, Center for Healthcare Delivery Science, Nemours Children’s Health System, Co-Director, Center for Pediatric Traumatic Stress (www.healthcaretoolbox.org), Professor, Department of Pediatrics, Thomas Jefferson University, Editor-in-Chief, American Psychologist.
Compiled by the Center for Drug Use and HIV | HCV Research (April 11, 2020). This site includes the following items:
This COVID-19 Quantitative Questionnaire was developed for MTN042/MTN-043, two trials in sub-Saharan Africa with pregnant (MTN-042/Deliver) and breastfeeding (MTN-043/B-protected) women.
The Pandemic Stress Index Survey
The Pandemic Stress Index is a measure of behavior changes and stress related to the COVID-19 pandemic developed at the University of Miami. The survey is available in Spanish, Turkish, Italian, Mandarin, Creole, Arabic, Portuguese, Lithuanian, and Greek.
This document provides guidance to Member States in the WHO European Region that wish to conduct behavioural insights studies related to COVID-19. The COVID-19 pandemic outbreak is placing an overwhelming burden on health systems and authorities to respond with effective and appropriate interventions, policies and messages. A poorly timed and managed pandemic response or transition phase can threaten the gains collectively achieved. The pandemic and its restrictions may have affected mental and physical well-being, social cohesion, economic stability as well as individual and community resilience and trust. In this complex context, understanding how, why and the context in which humans and communities respond allows to:
Population surveys can explore perceptions, acceptance of restrictions, mental and physical health, behaviours, information needs, misperceptions and more.
Massachusetts General Hospital Psychiatry Department
The Massachusetts General Hospital Psychiatry Department has an excellent set of comprehensive collated set of materials for COVID mental health for the general public
University of Miami Center for HIV and Research in Mental Health (CHARM)
The University of Miami Center for HIV and Research in Mental Health (CHARM) also has an excellent list of COVID-19 Mental Health Resources.
WHO Comprehensive Mental Health Action Plan 2013-2020
The WHO Comprehensive Mental Health Action Plan 2013-2020 is the global plan that sets out the indicators that all WHO Member states have agreed to deliver in order to improve mental health for all. This plan will be updated over the course of this year and Ministers of Health will approve the new plan for 2021-2030 in May 2021 at the World Health Assembly.
In the coming weeks and months, the WHO will be leading discussions with governments at regional and country level on the new plan and with stakeholders more broadly. The WHO is also holding two periods of online consultation on the updates to the plan.
Additional WHO Resources:
Mental health and psychosocial considerations during the COVID-19 outbreak
Social stigma associated with COVID-19
Dealing with Stress, Anxiety, and Grief during COVID-19
NIH Director's Blog - April 7, 2020
From Dr. Francis Collins’ NIH Director’s Blog. This is a discussion with Dr. Joshua Gordon, Director of NIH’s National Institute of Mental Health, about how physical distancing can affect our mental well-being during the COVID-19 pandemic
The Burden of COVID‐19 in People Living with HIV: A Syndemic Perspective
Shiau S et al., August 2020 - AIDS Behav.
Summary: The emergence of the novel coronavirus disease known as COVID-19 creates another health burden for people living with HIV (PLWH) who face multiple morbidities and may be at heightened risk for severe physical health illness from COVID- 19. Our abilities to address these morbidities in PLWH must be considered alongside the socially-produced burdens that both place this population at risk for COVID-19 and heighten the likelihood of adverse outcomes. These burdens can affect the physical, emotional, and social well-being of PLWH and interfere with the delivery of effective healthcare and access to HIV treatment. We posit that a syndemic framework can be used to conceptualize the potential impact of COVID-19 among PLWH to inform the development of health programming services.
Characterizing the Impact of COVID-19 on Men Who Have Sex with Men Across the United States in April 2020
Sanchez TH et al., July 1, 2020 - AIDS Behav.
Summary: The COVID-19 pandemic is reinforcing health inequities among vulnerable populations, including men who have sex with men (MSM). We conducted a rapid online survey of COVID-19 related impacts on the sexual health of 1051 US MSM. Many participants had adverse impacts to general wellbeing, social interactions, money, food, drug use and alcohol consumption. Half had fewer sex partners and most had no change in condom access or use. Some reported challenges in accessing HIV testing, prevention and treatment services. Compared to older MSM, those 15–24 years were more likely to report economic and service impacts. While additional studies of COVID-19 epidemiology among MSM are needed, there is already evidence of emerging interruptions to HIV-related services. Scalable remote solutions such as telehealth and mailed testing and prevention supplies may be urgently needed to avert increased HIV incidence among MSM during the COVID-19 pandemic era.
DAIDS COVID Guidance
March 13, 2020
DCLOT Memo - Resuming DAIDS GCLP Audits
April 29, 2020
Cross-Network Lab Recovery Memo
May 1, 2020
ACTG COVID19 Lab Memo
March 17, 2020
Resumption of Domestic Specimen Shipments to BRI
June 3, 2020
Resumption of Domestic Specimen Shipments to BRI
June 4, 2020
VQA IQA COVID-19 Announcement
March 26, 2020
VQA Notification Regarding Shipping and Controls
April 23, 2020
VQA HIV-1 Quant RNA June Proficiency Testing
June 2, 2020
VQA HIV-1 Drug Resistance Sequencing PT Update
June 12, 2020
CPQA COVID19 Guidance
March 27, 2020
LDMS PBMC Storage Guidance
April 1, 2020
HANC-facilitated COVID-19 Webinars
Find a repository of webinars hosted by the COVID-19 CAB Coalition.
NIH Clinical Trials to Test Antibody Treatments in COVID-19 Patients
Dr. Francis Collins and Dr. Anthony Fauci discuss the ACTIV-2 study launch and questions related to monoclonal antibodies.
Rise Above COVID: Introducing the ACTIV-2 Study (September 22, 2020)
This webinar introduces the ACTIV-2 Study, which will investigate possible treatments for mild to moderate COVID-19 in people 18 years old and up. Hosted by the University of Washington AIDS Clinical Trials Unit.
Learning from Historic Vaccine Research & the Latest on the mRNA-1273 Candidate (August 25, 2020)
AVAC held a webinar presentation and discussion with Dr. Barney Graham, the Deputy Director of the NIH’s Vaccine Research Center (VRC). Dr. Graham reviewed the rapid development timeline for COVID-19 vaccines and explored some of the recent and historic vaccine research developments that are being applied to this challenge. He also provided a specific update on the mRNA-1273 vaccine—a vaccine developed by Moderna and the NIH—which is undergoing testing in a Phase III clinical trial launched last month.
Recording and Slides: YouTube / Dr. Graham's Slides
AVAC HIV Advocates' Update on COVID-19 (March 23, 2020)
AVAC was joined by Dr. Carl Dieffenbach, Director of the Division of AIDS (DAIDS) at the NIH, and other partners, to answer questions about what we do and don’t know about COVID-19 and HIV, how to track research developments on the HIV front, what this new pandemic might mean for ongoing HIV research, and how the HIV community can contribute to the fight against COVID-19.
COVID-19 & HIV Full Meeting (March 24, 2020)
The University of Washington AIDS Clinical Trials Unit’s Community Advisory Board (UW ACTU CAB) held an online meeting focused on the COVID-19 pandemic. Dr. Rachel Bender Ignacio, Associate Director of the UW ACTU, presented and her excellent slides can be downloaded here.
COVID-19 & HIV Update: Impact on Communities & HIV/AIDS Clinical Research (April 2, 2020)
The Office of HIV/AIDS Network Coordination (HANC) hosted a webinar featuring Dr. Carl Dieffenbach, Director of the Division of AIDS (DAIDS) at the National Institute of Allergy and Infectious Diseases; Dr. Sarah Read, Deputy Director of the DAIDS; Manizhe Payton, Director of the Office of Clinical Site Oversight (OCSO) at DAIDS; and Dr. Jeffrey Schouten, HANC Director, in an effort to inform network stakeholders and community about the impact of COVID-19 on HIV research.
COVID-19: A clinical update for HIV care providers (April 1, 2020)
Hosted by the American Academy of HIV Medicine (AAHIVM) and Association of Nurses in AIDS Care (ANAC)).
Finding the Middle Ground: Managing Stress and Anxiety During the COVID-19 Crisis (May 7, 2020)
Dr. Steven Safren and Dr. Deborah Jones Weiss from the University of Miami discuss stress and anxiety management strategies for providers during the COVID-19 epidemic.
Discussion with Jon Cohen on HIV and COVID-19 Vaccine Research (May 13, 2020)
AVAC hosted an excellent webinar with Science Magazine’s Jon Cohen. Jon talked about the fast-growing pipeline of vaccine candidates for COVID-19, how COVID-19 research is evolving and building on HIV vaccine research and more. The recording and terrific slides have been posted by AVAC.
International AIDS Society (IAS) Webinars
The International AIDS Society (IAS) is organizing a series of webinars on the topic of COVID-19 and HIV to discuss the pandemic and its impact on people living with HIV. Through these webinar sessions, the IAS would like to provide an opportunity for discussion around the latest science, in addition to sharing learning and best practices in relation to COVID-19 and HIV between countries at different stages of the pandemic, especially in lower- and middle-income countries. View the webinars here.
Update on COVID-19 For NIAID HIV/AIDS Community Advisory Boards (June 10, 2020)
Dr. Anthony Fauci, Director of NIAID, NIH gave a talk to HIV network CABS. The recording is available on YouTube. View his excellent slide presentation.
Follow-up Discussion with Dr. Dieffenbach on COVID for NIAID CABs (June 23, 2020)
Steve Wakefield moderated a webinar discussion with Dr. Carl Dieffenbach.
COVID-19 and People Living with HIV (June 18, 2020)
The University of Washington’s AIDS Clinical Trials Unit Associate Director, Dr. Rachel Bender Ignacio, presented a webinar on COVID-19 and People Living with HIV to the ACTG’s Global Community Advisory Board.
Caring for Yourself & Others during the Covid-19 Pandemic: Managing Healthcare Workers’ Stress
Patricia Watson, PhD, National Center for PTSD - March 24, 2020
Patricia Watson, PhD, of the National Center for PTSD discusses ways that healthcare workers can manage stress — theirs and others’ — as we face the ever-changing circumstances of the COVID-19 pandemic.
Regulating emotions & building resiliency in the face of a pandemic
Luana Marques, PhD, Harvard Medical School - April 1, 2020
This webinar series was created to support the students and staff of the Harvard Medical School community, yet the lessons will be broadly applicable to all who are feeling the emotional strain of this unprecedented crisis.
Managing Anxiety Related to Taking Care of Patients during the COVID-19 Pandemic
Cheryl Gore-Felton, PhD, Debra Kaysen, PhD and Mickey Trockel, MD, PhD., Stanford Medicine - April 3, 2020
The Stanford Medicine COVID-19 Support Series was created out of recognition of the emotional dimension of the COVID-19 pandemic. This webinar addresses strategies that healthcare professionals may utilize to manage their anxiety related to caring for patients with COVID-19 infection.