HIV and COVID-19: Intersecting Epidemics With Many Unknowns

Catherine R. Lesko; Angela M. Bengtson


Am J Epidemiol. 2021;190(1):10-16. 

In This Article

Abstract and Introduction


As of July 2020, approximately 6 months into the pandemic of novel coronavirus disease 2019 (COVID-19), whether people living with human immunodeficiency virus (HIV; PLWH) are disproportionately affected remains an unanswered question. Thus far, risk of COVID-19 in people with and without HIV appears similar, but data are sometimes contradictory. Some uncertainty is due to the recency of the emergence of COVID-19 and sparsity of data; some is due to imprecision about what it means for HIV to be a "risk factor" for COVID-19. Forthcoming studies on the risk of COVID-19 to PLWH should differentiate between 1) the unadjusted, excess burden of disease among PLWH to inform surveillance efforts and 2) any excess risk of COVID-19 among PLWH due to biological effects of HIV, independent of comorbidities that confound rather than mediate this effect. PLWH bear a disproportionate burden of alcohol, other drug use, and mental health disorders, as well as other structural vulnerabilities, which might increase their risk of COVID-19. In addition to any direct effects of COVID-19 on the health of PLWH, we need to understand how physical distancing restrictions affect secondary health outcomes and the need for, accessibility of, and impact of alternative modalities of providing ongoing medical, mental health, and substance use treatment that comply with physical distancing restrictions (e.g., telemedicine).


People living with human immunodeficiency virus (HIV; PLWH) might be at particularly high risk for infection with and poor clinical outcomes from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the novel coronavirus that causes coronavirus disease 2019 (COVID-19), and for adverse health outcomes associated with physical distancing measures introduced to mitigate the SARS-CoV-2 epidemic. It is critical that we understand these risks to modify ongoing HIV care accordingly and to update future pandemic preparedness plans. Herein, we outline several research questions to frame this research agenda, and we highlight existing data and future opportunities to answer these questions. We focus mainly on the intersecting epidemics of SARS-CoV-2 and HIV in the United States, but many of the questions we pose apply to other settings as well.