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

The Role of Antiretroviral Medications in COVID-19 Disease Progression

Certain antiretroviral medications, such as lopinavir-ritonavir (a protease inhibitor), were proposed and partially evaluated as treatments for other, similar coronaviruses.[25] However, a trial of 199 patients randomized to lopinavirritonavir versus standard of care found only small differences in time to clinical improvement (hazard ratio = 1.24, 95% confidence interval: 0.90, 1.72) and 28-day mortality (risk difference = −5.8%, 95% confidence interval: −17.3%, 5.7%).[26] There was some hint that the impact of lopinavir-ritonavir on mortality was stronger if treatment was administered closer to symptom onset, although results were imprecise. Results were reported as indicative of "no benefit" of lopinavir-ritonavir, although associations were suggestive of a potentially protective effect.[26] While these results do not support initiating treatment with lopinavir-ritonavir in patients with SARS-CoV-2, they might suggest some benefit to PLWH on a lopinavir-ritonavir-containing antiretroviral therapy (ART) regimen who continue on treatment while infected with SARS-CoV-2.

Darunavir (another protease inhibitor) has also been hypothesized to potentially have therapeutic action against SARS-CoV-2; however, no trial results are yet available.

Thus far, in cohort studies of COVID-19 among PLWH, ART regimen has not been consistently associated with disease incidence or severity. In a small cohort (n = 88) of PLWH hospitalized with COVID-19 in New York, New York, being on a nucleoside reverse transcriptase inhibitor was protective against death.[24] In a cohort of over 77,000 PLWH receiving ART in Spain, being on a regimen containing tenofovir/emtricitabine (a nucleotide reverse transcriptase inhibitor and a nucleoside reverse transcriptase inhibitor, respectively) was protective against COVID-19 diagnosis and hospitalization.[27] Data on the association between ART regimen and COVID-19 outcomes are still too limited to support or exclude an effect of any particular regimen.