With HIV, It’s More Challenging To Fight COVID-19 Viral Infections

By Akanimo Sampson

Mercy, a pseudonym for privacy protection, has been living with HIV for more than a decade. She painstakingly maintains good hygiene knowing firsthand that people with HIV have impaired immune responses, making it more challenging to fight viral infections such as influenza or perhaps COVID-19.

Those who know better say HIV may result in increased susceptibility to secondary illnesses such as pneumonia, heart and lung diseases and death.

“I took all the precautions to protect myself, so I never thought I would get it”, Mercy says. She is right. Every day, she donned a mask and was vigilant about washing her hands or using hand sanitizer which made the ensuing fever, headaches, sore throat and COVID-19 diagnosis startling.

An essential worker, Mercy continued to work, mask on, during the pandemic. One day, she noticed additional signage on her floor asking people to wear masks and wash their hands regularly. She asked her manager if she should be concerned.

Everything is okay, replied her manager, who further explained that the signage was following county protocols to ensure people were complying with preventative measures.

“The next week I began to feel sick”, said Mercy, who is unsure where she contracted SARS-CoV-2, the virus that causes the novel coronavirus. “At first, I thought it was something transient.”

Mercy is not alone in her COVID-19 diagnosis.

Nigeria on Saturday, recorded 601 fresh confirmed cases and one death. Nigeria Centre for Disease Control (NCDC) says 51905 cases have so far been confirmed in the country, pointing out, ‘’38767 cases have been discharged and 997 deaths have been recorded in 36 states and the Federal Capital Territory, Abuja.’’

Of the 601 new cases reported from 21 states, Lagos logged 404 cases, distantly followed by Abuja’s 37, Oyo 19, Ondo 14, Abia 13, Enugu 13, Kaduna 13, Edo 12, Kano 12, Kwara 11, Ebonyi 10, Nasarawa seven, Ogun six, Osun five, Delta five, Niger five, Plateau four, Bayelsa four, Katsina three, Ekiti, and Imo two each.

As of August 19, 2020, the Centers for Disease Control and Prevention (CDC) reported more than 5.4 million cases of COVID-19 and 171,000 deaths in the United States.

COVID-19 began to make headlines in China in December 2019. Since then, the pandemic has affected millions of lives globally. Scientists rushed to understand the biology and epidemiology of the virus, yet there are still many unknowns.

For instance, is SARS-CoV-2 affecting sub-populations of patients with chronic diseases or illnesses differently?

Dr. Edward R. Cachay, an infectious disease physician who specialises in caring for people with HIV, and the team at the Owen Clinic at UC San Diego Health have specific questions about the impact of COVID-19 on their patients.

Are people living with HIV at higher risk for COVID-19 complications? What if the person has the HIV infection under control, will the symptoms be less severe? Are people with HIV more or less likely to contract COVID-19? Will the antiviral medications these patients take help or hinder a SARS-CoV-2 infection?

“These are important questions for this community and their care”, says Cachay. “Many of our friends, brothers, sisters and neighbors are living with HIV. Some of them are living with HIV for a long time and are doing quite well. When another wave of COVID-19 comes, which unavoidably will happen, we want to be more prepared to inform our community, stakeholders and policymakers.”

In an attempt to address some of these questions, Cachay designed a study that looks at what independent predictors, biological or psychosocial, contribute to a risk of adverse outcomes among people living with HIV who are infected with SARS-CoV-2 compared to those living with HIV who are not infected by the novel coronavirus. The dynamic model will capture how the pandemic shapes and changes over time in people with HIV.

The team, which includes investigators at the University of Washington and Fred Hutchinson Cancer Research Center in Seattle, is examining medical records of people who are living with HIV and have COVID-19 across eight academic centers in the US.

The data is derived from the CFAR Network of Integrated Clinical Systems (CNICS), a National Institutes of Health-funded research network with access to information from 35,000 patients’ electronic medical records that is collected from the country’s eight Center for AIDS Research facilities, including one at UC San Diego.

In 2018, 1.2 million people were living with HIV in the US, according to the CDC. Between 2014 and 2018, the number of new diagnoses increased by seven percent.

“It’s been difficult”, Mercy says. “After the COVID-19 diagnosis, everyone distanced themselves from me. They do not speak to me. It is as though I were just told I had HIV all over again.”

People living with HIV suffer from psychosocial disorders including depression, loneliness, stigma, poverty, homelessness as well as alcohol, drug and tobacco abuse, Cachay says, adding, “when the response to COVID-19 came, rightfully so, we were asked to social distance.

“Ironically, our patients became more isolated, lonelier than ever, and raised more questions about their health than for the average citizens. It was our patients’ perceptions that inspired us to study the impact of COVID-19 on people with HIV.”

According to Cachay, the longer people live with HIV, the higher the risk of developing additional medical complications such as diseases of the kidney, heart and lung. Along with access to healthcare and psychosocial disorders, the combination of these biological factors and social determinants may play a role in the severity of illness as well as the ultimate outcome. He hopes his research will narrow the disparities and help people like Mercy.

Thankfully, Mercy’s symptoms, while persistent, have not been severe or required hospitalisation. But the impact is profound. She wants people to know about the emotional toll the disease and society can have on people with COVID-19.

“Instead of being scared of us or isolating from loved ones, we should be more united—just with added precautions”, Mercy said, pointing out, “apart from being immune-compromised, it is the solitude and rejection that causes us to become sicker.”

At the moment, global health authorities say European countries should be able to ride out a surge in coronavirus cases without re-imposing full lockdowns, as the World Bank warned the crisis could push 100 million people into extreme poverty.

Worrying spikes in cases reported Thursday in France, Italy, Spain and Germany showed the pandemic was rebounding across the continent—often due to travel, summer holidays and parties.

While Italy registered 845 new cases on Thursday, its highest daily tally since May, France reported 4,700 fresh infections—a massive increase on the previous day. Spain’s daily increases topped even those of France, and Germany was concerned about its own resurgence.

Despite the rise in cases, a top World Health Organisation (WHO) official says additional lockdowns should not be necessary.

Head of the WHO’s European branch, Hans Kluge, told reporters, “with the basic nationwide and additional targeted measures, we are in a much better position to stamp out these localised virus flare-ups. We can manage the virus and keep the economy running and an education system in operation.”

The coronavirus pandemic may have driven as many as 100 million people back into extreme poverty, World Bank President David Malpass warned on Thursday in an interview with AFP.

 The Washington-based development lender previously estimated that 60 million people will fall into extreme poverty, but the new estimate puts the deterioration at 70 to 100 million, and he said “that number could go higher” if the pandemic worsens or drags on, which is possible.

Already, the death toll from the virus in Latin America surged past 250,000.

Nine months after the virus began sweeping across the world from China last December, the pandemic has hit the Americas harder than anywhere else.

Latin America and the Caribbean recorded nearly 6.5 million infections and 250,969 deaths by 2200 GMT Thursday, according to an AFP tally based on official national figures. Globally, the virus has claimed at least 788,242 lives.

Brazil is the region’s worst-affected country with 3.5 million cases and more than 112,000 deaths. This South American giant is second only to the US as the world’s worst-hit country.

Peru, where figures released Thursday showed a 30 percent fall in GDP in the second quarter, has registered more than 26,000 deaths.

Economic toll

The crushing economic damage has sprung not just from the virus itself but also from the lockdowns that largely halted business activity across the world.

The US—where 174,000 people have died—continues to bear the brunt in health terms and is suffering grim economic fallout. The number of Americans filing claims for joblessness each week topped one million again, US officials said on Thursday, an increase on the previous week’s figures.

Germany will need to take on yet more debt in 2021 to mitigate the impact of the coronavirus on the economy, Finance Minister Olaf Scholz said.

“Next year we will continue to be forced to suspend the debt rule and spend considerable funds to protect the health of citizens and stabilise the economy”, Scholz said in an interview with the Funke media group, referring to Germany’s cherished policy of keeping a balanced budget.

The government has pledged over a trillion euros in aid to shield companies and citizens in Europe’s top economy from the pandemic fallout, including through loans, grants and subsidised shorter-hours programmes.

Vaccine hopes

Worrying trends emerged in India as a new study suggested more than a quarter of Delhi’s 20 million people may have been infected without showing symptoms—backing up several similar studies.

The figures added urgency to the desperate bid to find a vaccine for the virus, which has infected more than 22 million and killed hundreds of thousands since it first emerged in China late last year.

Russia on Thursday announced it was pushing forward with testing on more than 40,000 people of its candidate drug, known as Sputnik V, which has already been hailed by Russian officials as a success even as experts questioned the rigour of the testing regime.

Several drugs are approaching the mass-testing phase, and countries around the world have been pre-ordering many millions of doses.

The EU said on Thursday it had concluded talks with a German pharmaceutical firm to secure 225 million doses of a potential vaccine—the fourth such agreement the bloc has reached.

French President Emmanuel Macron hailed European cooperation on the issue and said he was hopeful that a vaccine would come online with the next few months. “This will not solve the problems of the next few weeks, but of the next few months”, he said.

However, while a vaccine remains elusive, governments are left trying to control the spread through social-distancing measures, quarantines, travel bans and restrictions on businesses.

In the mean time, WHO is hoping the planet will be rid of the coronavirus pandemic in less than two years—faster than it took for the Spanish flu.

Tedros Adhanom Ghebreyesus told reporters from the WHO’s headquarters in Geneva,”e hope to finish this pandemic before less than two years”,  insisting that it should be possible to tame the novel coronavirus faster than the deadly 1918 pandemic.

Compared to back then, the world today is at a disadvantage due to its “globalisation, closeness, connectedness”, which has allowed the novel coronavirus to spread around the world at lightning speed, Tedros acknowledged.

But the world also now has the advantage of far better technology, he said.

By “utilising the available tools to the maximum and hoping that we can have additional tools like vaccines, I think we can finish it in a shorter time than the 1918 flu.”

But the deadliest pandemic in modern history, Spanish flu, killed as many as 50 million victims and infected around 500 million around the world between February 1918 and April 2020.

Five times more people died of it than did in World War I. The first victims were recorded in the United States, before it spread to Europe and then around the world.

That pandemic came in three waves, with the deadliest second wave beginning in the latter half of 1918.

“It took three waves for the disease to infect most of the susceptible individuals,” WHO emergencies chief, Michael Ryan, told journalists.

After that, the flu virus behind the pandemic evolved into a far less deadly seasonal bug, which returned for decades.

“Very often, a pandemic virus settles into a seasonal pattern over time”, Ryan said, and warned that so far, “this virus is not displaying a similar wave-like pattern. Clearly, when the disease is not under control, it jumps straight back up.”