COVID-19 Susceptibility and Outcomes Among People Living With HIV in San Francisco

Discussion

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,^[6] 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.^[12] 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,^[1] 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,^[6] 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,^[9] and continuity of care are required as we try to protect people living with HIV from SARS-CoV-2 infection worldwide.

J Acquir Immune Defic Syndr. 2021;86(1):19-21. © 2021 Lippincott Williams & Wilkins