These data from a high HIV incidence city in the United States add to the growing literature around HIV and COVID-19 coinfection and are consistent with larger studies published to date from the United States and Europe suggesting that HIV does not seem to predispose to more severe COVID-19 outcomes.[6,10] Small studies in the New York City have suggested worse outcomes among PLWH, but not consistently, and data reporting was from a time when the hospitals were exceeding capacity. Our report, similar to the one conducted in Spain, does suggest an increased incidence of SARS-CoV-2 infection among HIV compared with people without HIV in San Francisco from the date community transmission was reported (March 5, 2020) to September 3, 2020 (4.5% vs. 3.5%, P 0.00004). This may be due to the fact that a number of HIV/COVID-19 coinfected patients in our study were in congregate living situations such as single residency occupancy hotels, homeless shelters, and long-term care facilities. Shared bathrooms and crowded spaces make social distancing challenging.
Indeed, with 45.4% of the HIV/COVID-19 coinfected people in this study experiencing marginal housing, housing status is the most likely contributor to the increased susceptibility to SARS-CoV-2 among PLWH in San Francisco. A large outbreak in a homeless shelter in San Francisco occurred near the beginning of the study period. New HIV infections are also higher and virologic suppression rates lower among PLWH with unstable housing compared with those who are housed in San Francisco, consistent with the disparities seen with COVID-19 susceptibility.
Our data indicate that specific policies to reduce risk of COVID-19 transmission among PLWH are indicated, including limiting exposures in high-risk congregate settings. San Francisco has taken steps to house people with unstable housing preferentially during the COVID-19 pandemic, but more efforts are needed countywide to house those who are homeless as a public health measure. Medical care of homeless individuals with and without HIV is paramount during a pandemic. Housing assistance, continuation of ART, and continuity of care are required as we try to protect people living with HIV from SARS-CoV-2 infection worldwide.
Funding source for this report
NIAID/NIH R01AI158013 (M.G.: P.I.)
J Acquir Immune Defic Syndr. 2021;86(1):19-21. © 2021 Lippincott Williams & Wilkins