key: cord-0721445-wc7ivnvp
authors: Barbera, Lauren K.; Kamis, Kevin F.; Rowan, Sarah E.; Davis, Amelia J.; Shehata, Soraya; Carlson, Jesse J.; Johnson, Steven C.; Erlandson, Kristine M.
title: HIV and COVID-19: review of clinical course and outcomes
date: 2021-09-12
journal: Hiv Research & Clinical Practice
DOI: 10.1080/25787489.2021.1975608
sha: e1f9b59dcc26088e70b179408a40c961ebbbda0d
doc_id: 721445
cord_uid: wc7ivnvp

Background:Understanding the relationship between HIV and SARS-CoV-2 has important public health implications. Objective:To summarize current research on COVID-19 among people with HIV (PWH) as published through 15 July 2021. Methods: We conducted a search of PubMed, Scopus, preprint databases (medRxiv, bioRxiv), and the references of publications found using key terms relevant to COVID-19 (‘COVID-19’ OR ‘SARS-CoV-2’ OR ‘coronavirus’) AND to HIV (‘HIV’ OR ‘Human Immunodeficiency Virus’ OR ‘AIDS’ OR ‘Acquired Immunodeficiency Syndrome’). We summarized all articles that reported data or opinions on SARS-CoV-2 and HIV coinfection. Conclusions: Although many initial case series and cohort studies found no increased risk for SARS-CoV-2 infection or severe COVID-19 outcomes among PWH, recent studies have signaled an increased risk for severe COVID-19 disease progression even in the setting of well-controlled HIV. Whether this is due to the increased prevalence of comorbidities in PWH and other social determinants of health is unknown. These conflicting findings highlight the continued need for COVID-19 related research among PWH that addresses COVID-19 disease course as well as exacerbation of existing comorbidities already disproportionately represented among PWH.

When COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, began to surface in late 2019 and early 2020, healthcare officials and providers assumed that individuals with Human Immunodeficiency Virus (HIV) infection and other immunocompromising conditions would be at particularly high risk of both acquisition and severe disease. 1 Without effective antiretroviral therapy (ART), HIV leads to depletion of CD4 T-lymphocytes, resulting in a weakened adaptive immune response. 2 In the presence of effective ART, the cellular immune response recovers to variable degrees; however, individuals with HIV appear to remain at greater risk for many infections, including pneumococcal pneumonia, influenza, meningococcal disease, herpes virus infections, and tuberculosis. [2] [3] [4] [5] [6] [7] As COVID-19 precipitated widespread closures of businesses, schools, and community gatherings, healthcare agencies, and other critical operations scrambled to determine how to provide essential services to patients while protecting their employees. In an attempt to limit potential spread to patients and employees, many clinics converted to virtual or telephone-based visits. 8 However, as businesses, schools, and healthcare facilities have gradually resumed inperson services, the ongoing risk for acquiring SARS-CoV-2 infection, or developing severe disease, remain somewhat elusive.

While increasing age, obesity, diabetes, and Black or Hispanic race/ethnicity have consistently been linked to acquisition and severe disease in U.S. populations, the role of other factors, such as HIV, in contributing to risk of COVID-19 acquisition and disease severity have been less certain. [9] [10] [11] [12] [13] [14] Furthermore, people with HIV (PWH) frequently have overlapping risk factors for COVID-19, often at rates higher than the general population. These risks include being male, Black or Hispanic, smoking, older age, and medical comorbidities. [15] [16] [17] [18] [19] [20] [21] [22] [23] Lastly, despite effective ART, PWH have higher levels of inflammation, one of the key factors driving the development of severe respiratory disease, thromboembolic disease, and other poor outcomes with COVID-19. 24, 25 Parsing out the added risk of HIV with or without ART in the setting of these other epidemiologic and physiologic risks is therefore challenging.

To better understand what is currently known about the relationship between HIV and COVID-19 acquisition and disease severity, we conducted a search of PubMed, Scopus, preprint databases (medRxiv, bioRxiv), and the references of publications found using key terms relevant to COVID-19 ('COVID-19' OR 'SARS-CoV-2' OR 'coronavirus') AND to HIV ('HIV' OR 'Human Immunodeficiency Virus' OR 'AIDS' OR 'Acquired Immunodeficiency Syndrome') between 1 March 2020 and 15 July 2021. Of 2210 initial results we considered each study that reported data or opinions on COVID-19 among PWH, applying extra filters to access articles related to 'symptoms', 'severity', 'hospitalization', 'mental health', 'access to care', and 'ART'. This resulted in the 212 articles presented in this review. We then summarized the risk for acquiring COVID-19, presenting symptoms of COVID-19, severity of COVID-19 illness, and impacts on mental health and access to care during the COVID-19 pandemic. We also report findings on the effects of antiretroviral therapy on COVID-19 risk and outcomes for PWH.

Are people living with HIV more likely to contract SARS-CoV-2?

Many experts initially considered individuals living with HIV as a vulnerable group with regards to SARS-CoV-2 infection due to a greater burden of some comorbidities, higher systemic inflammation despite effective ART, and some degree of immune alteration even among those on effective ART with immune reconstitution. [26] [27] [28] [29] [30] [31] [32] Whether this is true remains unclear. PWH account for approximately 0.7% of the general population of adults in the world, and roughly 0.5-1.5% of COVID-19 cases in various COVID-19 case series and cohort studies. 28, [33] [34] [35] [36] One prospective cohort study of 5683 PWH observed a lower incidence of COVID-19 among PWH compared to the general population, suggesting a possible protective effect of HIV, ART, or less exposure through physical isolation and consistent use of personal protective equipment. 37 However, this study was limited in that it did not control for ART use. Multiple other prospective cohort studies, limited by their study sizes, have found similar rates of SARS-CoV-2 among PWH and the general population. [38] [39] [40] [41] A study from San Francisco of 4252 PWH suggested that PWH were more susceptible to SARS-CoV-2 infection than those without HIV. 42 Numerous other confounders, however, may have explained these differences: for example, 8% of PWH in San Francisco experience unstable housing as compared to the 1% of the San Francisco general population. 42 As of 28 July 2020, the Centers for Disease Control and Prevention concluded that based on the limited data available, PWH on effective ART appear to have a similar risk for acquisition of SARS-CoV-2 as people who do not have HIV. 43 It is important to note that multiple studies have attempted to distinguish the difference between test positivity and disease incidence. In a recent analysis of over 30,000 PWH in the USA, PWH were more likely to be tested for SARS-CoV-2 but did not have an increased percentage of COVID-19 positivity compared to individuals without HIV. 44 However, the authors note that testing shortages and the potential for differential adherence to stay-at-home guidance by immunosuppression status could have influenced the outcome of the study. In contrast, researchers in Southern Italy found that PWH were more reluctant to obtain SARS-CoV-2 testing and thus were likely underdiagnosed with COVID-19, though this was an opinion piece and the conclusion was not backed by data. 45 Do the presenting symptoms of COVID-19 differ among people with or without HIV?

In the general population, the most common presenting symptoms of COVID-19 include fever, cough, or shortness of breath (70%) and less commonly muscle aches (36%), headaches (34%), and loss of smell or taste (8%). 9 A cohort of 286 PWH showed similar symptoms: cough (76.2%), fever (70.7%), and fatigue (66.0%). 20 This study was especially strong as it took data from multiple states and countries. These results have been supported by numerous other studies. [46] [47] [48] [49] [50] [51] [52] [53] Besides one review, these studies are limited in their small sample size. Of note, other individual case studies have found that PWH may present with COVID-19 and opportunistic infections such as Pneumocystis jirovecii pneumonia and AIDS-related disseminated histoplasmosis, perhaps exacerbated by or contributing to presenting symptoms of COVID-19. [54] [55] [56] [57] [58] [59] [60] Are people living with HIV more likely to present with severe disease and/or be hospitalized for COVID-19?

Similar to the general population, age and co-morbidities appear to be the strongest predictors of severe disease and mortality in PWH. 22, 46, [61] [62] [63] [64] [65] [66] [67] [68] [69] [70] [71] [72] [73] Most PWH who develop symptomatic COVID-19 have at least one comorbidity, most commonly hypertension, dyslipidemia, or type 2 diabetes mellitus. 28 20 Data describing the likelihood of hospitalization due to COVID-19 among PWH is limited and mixed: rates of hospital admission among people living with HIV range from 0.8% to 1.8%. 33, 38, 74, 79 Notably, these rates derive from cohorts in numerous countries including Spain, China, and the United States, which may differ demographically with varying rates of comorbidities and clinical threshold for hospitalization. A retrospective, matched cohort study at a New York health system indicated PWH (n ¼ 21) had a significantly higher rate of hospital admission but not intensive care unit admission, mechanical ventilation, or mortality, compared to people without HIV (n ¼ 42). 80 All PWH in this cohort were on ART, the majority had an undetectable viral load, and only six of 19 had a CD4 count < 200 cells/uL, thus limiting the ability to determine the effect of HIV severity of COVID-19 outcomes. A separate small analysis of 31 PWH hospitalized at a New York, NY hospital also found similar rates of hospitalization among those with or without HIV. 35 In a much larger Veteran cohort of 107,636 patients with COVID-19, risk of hospital admission among PWH did not differ from those without HIV, although these results have not yet been published in a peer-reviewed paper. 44 In a retrospective study in New York comparing 21 PWH with 42 matched-uninfected controls admitted with COVID-19, a similar burden of comorbidities and similar admission laboratory values were seen between PWH and uninfected controls. 80 In addition, no statistically significant differences were seen between PWH and the uninfected controls when comparing consolidation, infiltrate, or opacity on chest imaging. 80 Although the study was small, findings are strengthened by matching PWH and controls by admission date, age, body mass index, gender, tobacco history, and a history of chronic kidney disease, hypertension, asthma, chronic obstructive pulmonary disease, and heart failure. In summary, among PWH, risk factors for hospitalization and clinical presentation at the time of hospitalization appear to be influenced more by comorbidities or demographic risk factors seen in the general population (race/ethnicity, socio-economic status), and less by HIV-specific factors.

Are people with HIV more likely to have severe outcomes?

A number of studies on HIV and SARS-CoV-2 coinfection have addressed the question whether PWH have more severe outcomes than the general population (as defined by more ICU admissions, greater need for mechanical ventilation, and higher mortality rates). As summarized in Table 1 , many large studies and smaller case reports have found greater likelihood of ICU admission and higher mortality rates among PWH than the general population. 76,81-91 Indeed, of 3,460,932 patients in the public sector in South Africa, 16% were PWH and 22,308 (0.6%) were diagnosed with COVID-19. In this large study, HIV infection was associated with a doubling of COVID-19 mortality risk, independent of CD4 count or HIV viral load (though >90% were virologically suppressed). 91 . In a study of 17,282,905 adults (including 27,480 PWH) in the United Kingdom, a substantially higher risk of mortality was seen with COVID-19 in PWH than in the general population, although the actual number of deaths among PWH was only 25, thus limiting some of the conclusions. 19 Furthermore, data were available on some comorbidities and demographics but not HIVrelated characteristics (ART, CD4 count, or viral load). A landmark report by the World Health Organization (WHO) included 15,522 PWH and 168,649 adults without known HIV hospitalized with suspected or confirmed SARS-CoV-2 from 24 countries (96% from the WHO African Region). 92 HIV was associated with an increased risk of severe or critical disease at admission compared to uninfected controls, after adjusting for age, sex, and underlying comorbidities. HIV was also independently associated with higher mortality risk. The majority of persons included were from South Africa, and no data were presented on ART, CD4 count, or virologic suppression. 92 Two systematic reviews/meta-analyses also concluded that PWH had a higher risk of mortality, though only in studies of PWH from Africa and the United States. 93, 94 A smaller study of PWH in Brazil (n ¼ 255) found that being Black/Mixed race and having lower education were associated with greater mortality in adjusted models, while age, sex, CD4 count, viral load, and 23 4 PWH Turkey 29-Apr-20 J Med Virol Comorbidities are an important factor in mortality for coinfected PWH Ridgway, J.P. 41 8 PWH/1061 HIV negative controls USA 7-May-20 AIDS Behav PWH did not test positive for COVID-19 at a different rate than the general population Hӓrter, G. 47 33 PWH Germany 11-May-20 Infection PWH did not have more severe morbidity or mortality than the general population Gervasoni, C. 105 84 72 PWH USA 30-Jun-20 J Infect Dis PWH were at higher risk for severe COVID-19 outcomes, especially those with increased markers of inflammation and immune dysfunction Guo, W. 76 14 PWH China 1-Jul-20 J Int AIDS Soc HIV and COVID-19 coinfection led to a higher mortality rate and higher proportion of severe cases than the general population Park, L.S. 44 30,891 PWH/ 76,745 HIV negative controls USA 6-Jul-20 AIDS 2020 Conference PWH had higher COVID-19 testing rates but no evidence to support increased positivity or more severe outcomes Ruan, L. 102 4 PWH China 6-Jul-20 J Med Virol PWH in the stage of AIDS had a more complicated clinical course than those not in AIDS Gudipati, S. 112 14 PWH USA 15-Jul-20 J Acquir Immune Defic Syndr PWH were not at a higher risk for severe COVID-19 outcomes Mahmood, K. 196 1 PWH USA 15-Jul-20 JACC Case Rep Coinfected PWH on a LVAD Cooper, T.J. 140 70 comorbidities were not. 63 To the best of our knowledge, thus far only one study has investigated the risk of post-acute symptoms following COVID-19 and found that moderate to severe disease was associated with an increased risk of persistent symptoms in PWH. 95 Dandachi et al. (n ¼ 286) noted that patients with lower CD4 counts (<200 cells/mm 3 ) may be at risk for more severe outcomes despite viral suppression and this was supported by other smaller studies. 20, 72, 84, [96] [97] [98] [99] [100] [101] [102] [103] The results of Dandachi et al. are strong and generalizable as they pull data from 36 institutions across 21 states and three countries. However, the study did not collect data on social determinants of health or COVID-19 therapies, which may have differed and confounded the results. Greater comorbidity burden in PWH has also been associated with more severe COVID-19 outcomes. 20, 28, 46, 64, 76, 77, 104 Other studies suggest that PWH have fewer COVID-19 complications, fewer admissions to the ICU, and lower mortality rates (as seen in Table  1 ). [105] [106] [107] [108] [109] [110] [111] Larger cohorts from Spain, Italy, and the USA as well as many smaller studies have found no association or an unclear association between severity of outcomes such as ICU admission, need for mechanical ventilation, or mortality rates and HIV serostatus. 34, 38, 44, 61, 74, 80, 99, In general, PWH appear to be at higher risk for severe COVID-19 outcomes even after considering demographic factors and comorbidities associated with severe disease. However, it is important to note that due to the quickly changing testing procedures and requirements for hospitalization throughout the pandemic, as well as the reliance on public health surveillance data and/or medical record review, the ability to truly distinguish severity of outcomes in PWH is difficult and often confounded. 148 Regardless, preventive measures for PWH should be strongly encouraged (particularly vaccination) to limit disease severity.

The social distancing and quarantine strategies required to reduce the spread of SARS-CoV-2 have left many feeling isolated and lonely. This is especially impactful to PWH as they have increased worry about physical health (68%), mental health (66%), finances (50%), and accommodation (25%) during the COVID-19 pandemic. 149 One study found that of 703 PWH, 61% of PWH reported depressive symptoms, 50% noted anxiety symptoms, and 39% experienced recent insomnia. 150 Other smaller studies have also found increased rates of depression, anxiety, insomnia, and substance abuse in relation to the COVID-19 pandemic. [151] [152] [153] [154] [155] [156] [157] [158] [159] [160] [161] [162] Importantly, these rates are lower amongst people who report strong levels of social support in a large study from two countries. 163 How does COVID-19 impact access to care for PWH?

The COVID-19 pandemic has restricted access to care for much of the population by restricting public transportation, suspending routine appointments, and adding financial hardships. PWH specifically are at high risk of treatment interruption due to reduced access to HIV clinics, reduction in primary care or specialty referrals, and difficulties refilling ART prescriptions. 150, 156, 157, [164] [165] [166] [167] [168] [169] [170] [171] [172] [173] [174] [175] [176] Telemedicine has proven to be very effective in many countries as it provides flexibility in scheduling appointments, reduces the need for transportation, and provides privacy for patients not wanting to be seen attending an HIV clinic. 149, [177] [178] [179] [180] [181] [182] [183] [184] However, telemedicine also presents barriers including technological challenges, client/provider experiences, digital literacy, low socio-economic status of client population, and reimbursement issues. [185] [186] [187] Many countries have identified this imbalance in access to care both with HIV diagnosis and ongoing care and have provided at-home testing kits, distributed condoms with COVID-19 testing services, and mailed ART to ensure continuity of care. [188] [189] [190] [191] [192] [193] How does ART influence acquisition of SARS-CoV-2 or severity of COVID-19?

In the USA, an estimated 61.5% of the 1.2 million persons living with HIV are virologically suppressed using ART. 194 Consequently, most PWH who develop COVID-19 will be on suppressive ART. While maintaining suppressed viral load and a normal CD4 Tlymphocyte count likely decreases the risk of severe COVID-19, there is yet to be clear evidence that ART itself prevents the acquisition of SARS-CoV-2 infection or alters the rate of progression to severe disease. 51, 144, [195] [196] [197] [198] [199] [200] [201] Three observational studies have suggested a potential protective role of tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) among PWH. 91, 202, 203 The last of these adjusted for comorbidities, demographics, country of birth, and education level. As TDF/FTC tends to be avoided due to toxicity among older patients with more comorbid conditions, this finding may be due to confounders of younger age and fewer comorbidities, rather than a protective effect of the drug. 91, 202 Similarly, the HIV protease inhibitor lopinavir-ritonavir has in vitro activity against SARS-CoV-2 and some speculate that it may be protective against COVID-19. 204 With regards to COVID-19 treatment, there are no significant drug-drug interactions between remdesivir and ART. Dexamethasone is an inducer of hepatic metabolism of drugs and could decrease the levels of some co-administered ART. 215 As the course of dexamethasone is typically limited to 10 days or less, it is unlikely that this interaction will be significant in most circumstances. If there is a need to adjust or change ART, consultation with an HIV specialist is recommended. For critically ill patients who require enteral feeding, some ART are available in liquid formulations and some pills may be crushed. Clinicians should consult an HIV specialist and/or pharmacist to assess the best way for a patient with a feeding tube to continue an effective regimen. Regarding prophylaxis for opportunistic infections, whether the lymphopenia associated with COVID-19 places PWH at higher risk for opportunistic infections is not currently known. As this lymphopenia is limited, the risk of acquiring infections is not expected to alter prophylactic therapy. As COVID-19 may occur more commonly in people with limited prior access or engagement to the healthcare system, the hospitalization is an opportunity to screen for HIV and other infections (hepatitis C, tuberculosis), as indicated. For persons who present with COVID-19 and a new diagnosis of HIV infection, the timing of starting ART is currently unknown. Currently, the Department of Health and Human Services guidelines recommend immediate initiation of ART in persons with newly diagnosed HIV infection. 214 Immune reconstitution could help in the management of SARS-CoV-2 infection. In contrast, immune reconstitution could also exacerbate the inflammatory response and worsen respiratory failure or contribute to a hypercoagulable state in others.

Other characteristics such as renal failure, thrombosis, or mechanical ventilation might suggest a delay in ART initiation to avoid further exacerbating inflammation. Consultation with an HIV specialist is advised. 

Although initial case studies and small cohorts found similar rates of infection and severity in PWH, the growing literature in diverse settings throughout the course of the pandemic now suggests that PWH are at greater risk for severe disease, even with well-controlled HIV. As the pandemic continues, PWH should be counseled regarding the heightened risk from HIV, in addition to other demographic or comorbid factors. Precautions to limit unnecessary exposure and decrease risk for acquisition (i.e. handwashing, physical distancing, mask wearing) should be encouraged particularly during surges in infection rates. While the general care of PWH who also acquire SARS-CoV-2 infection does not differ from people without HIV, certain considerations regarding drug-drug interactions can be guided through consultation with an HIV specialist. Lastly, while separate from the direct complications of COVID-19, the isolation and loneliness experienced during this pandemic, potential interruptions of medication therapy, and reduced access to care may have an even more profound effect on those experiencing the stigma of HIV. Ensuring that PWH are able to stay connected to local resources and monitoring for the impact on mental health and well-being will have important long-term implications.

No potential conflict of interest was reported by the authors. 

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HIV and SARS-CoV-2 co-infection: cross-sectional findings from a German 'hotspot'

High HIV prevalence in an early cohort of hospital admissions with COVID-19 in Cape Town

COVID-19 in people living with HIV: a multicenter case-series study

Driving force of covid-19 among people living with HIV/AIDS in Wuhan, China L. K. Barbera et al. HIV and COVID-19: review of clinical course and outcomes HIV Research & Clinical Practice

Coronavirus disease 2019 in patients with HIV in the province of Araba

Coronavirus disease 2019 (COVID-19) outcomes in HIV/AIDS patients: a systematic review

Cases of coronavirus disease-2019 in HIV-infected transgender women

COVID-19 pneumonia in patients with HIV: a case series

COVID-19 in people with HIV

SARS-CoV-2 infection in people living with HIV: a systematic review

COVID-19 in HIV-infected patients: a case series and literature review

Evolution of SARS-CoV-2 neutralizing antibody in an HIV-positive patient with COVID-19

HIV/SARS-CoV-2 coinfection: a global perspective

COVID-19 death in people with HIV: interpret cautiously

The impact of the COVID-19 pandemic on people living with HIV in Victoria, Australia

Challenges to HIV care and psychological health during the COVID-19 pandemic among people living with HIV in China

AIDS and COVID-19 infections: impact on vulnerable Indian population

The impact of COVID-19 on HIV selfmanagement, affective symptoms, and stress in people living with HIV in the United States

Knowledge and impact of COVID-19 on middle-aged and older people living with HIV in

Follow-up survey of the impact of COVID-19 on people living with HIV during the second semester of the pandemic

Consequences of COVID-19 crisis for persons with HIV: the impact of social determinants of health

Collateral damage: impact of SARS-CoV-2 pandemic in people living with HIV

Impact of the COVID-19 pandemic on the medical follow-up and psychosocial well-being of people living with HIV: a cross-sectional survey

The burden of anxiety during the COVID-19 pandemic among people living with HIV (PLHIV) in Pune

COVID-19-related anxiety in people living with HIV: an online cross-sectional study

The virus that changed Spain: impact of COVID-19 on people with HIV

The burden of COVID-19 in people living with HIV: a syndemic perspective

Psychological distress during the initial stage of the COVID-19 pandemic in an Italian population living with HIV: an online survey

Mental health, coping, and social support among people living with HIV in the Americas: a comparative study between Argentina and the USA during the SARS-CoV-2 pandemic

The parallel fight against HIV and COVID-19

HIV services in times of COVID-19

Epidemiology of reported HIV and other sexually transmitted infections during the COVID-19 pandemic

HIV in the age of COVID-19

Short-term effects of the COVID-19 pandemic on HIV care utilization, service delivery, and continuity of HIV antiretroviral treatment (ART) in Haiti

COVID-19 in patients living with human immunodeficiency virus (HIV) infection: challenges and way-forward

Antiretroviral treatment interruption among people living with HIV during COVID-19 outbreak in China: a nationwide cross-sectional study

Challenges to HIV service delivery and the impacts on patient care during COVID-19: perspective of HIV care providers in Guangxi

The interplay between HIV and COVID-19: summary of the data and responses to date

Consequences of the COVID-19 pandemic on the continuum of care in a cohort of people living with HIV followed in a single center of Northern Italy

COVID-19 pandemic disrupts HIV continuum of care and prevention: implications for research and practice concerning community-based organizations and frontline providers

Maintaining HIV care during the COVID-19 pandemic

Telemedicine for HIV care: current status and future prospects

People living with human immunodeficiency virus during the COVID-19 pandemic: experiences with telemedicine

HIV prevention and treatment in the context of the COVID-19 in the Bronx

Telemedicine as a tool for PrEP delivery during the COVID-19 pandemic in a large HIV prevention service in Rio de Janeiro-Brazil

Development of telemedicine infrastructure at an LGBTQ þ clinic to support HIV prevention and care in response to COVID-19

Transitioning to Telehealth during the COVID-19 pandemic: patient perspectives and attendance at an HIV clinic in San Francisco

Evaluation of virologic suppression rates during the COVID-19 pandemic with outpatient interdisciplinary HIV care

Video-based HIV testing services among cisgender men who have sex with men as a component of an HIV behavioural surveillance study during the COVID-19 pandemic in New York City: implementation, feasibility and lessons learned

Telehealth for HIV care services in South Carolina: utilization, barriers, and promotion strategies during the COVID-19 pandemic

Exploring the social impacts of the COVID-19 pandemic on people living with HIV (PLHIV): a scoping review

The impact of COVID-19 on HIV care provided via telemedicine-past, present, and future

How Myanmar is working to maintain essential services for people living with HIV and key populations during the Covid-19 pandemic

HIV self-testing partially filled the HIV testing gap among men who have sex with men in China during the COVID-19 pandemic: results from an online survey

Caring for people living with HIV during the global coronavirus disease 2019 pandemic

Ensuring retention in care for people living with HIV during the COVID-19 pandemic in

HIV care during the coronavirus disease-2019 pandemic in Shenzhen, China

Addressing health inequities exacerbated by COVID-19 among youth with HIV: expanding our toolkit

Vital signs: status of human immunodeficiency virus testing, viral suppression, and HIV preexposure prophylaxis -United States

COVID-19 and VIH

Predisposition or protection?: COVID-19 in a patient on LVAD support with HIV/AIDS

Coinfection with HIV and SARS-CoV-2 in Wuhan, China: a 12-person case series

Novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) co-infection with HIV: clinical case series analysis in North Central Nigeria

Computed tomography imaging of an HIV-infected patient with coronavirus disease 2019

Antibody response to SARS-CoV-2 in people living with HIV

Could HIV infection alter the clinical course of SARS-CoV-2 infection? When less is better

Incidence and severity of COVID-19 in HIV-positive persons receiving antiretroviral therapy: a cohort study

Prevalence and factors associated with SARS-CoV-2 seropositivity in the Spanish HIV research network cohort

Early combination treatment with existing HIV antivirals: an effective treatment for COVID-19?

A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19

Is a step-down antiretroviral therapy necessary to fight severe acute respiratory syndrome coronavirus 2 in HIV-infected patients?

Efficacy and safety of lopinavir/ritonavir for treatment of COVID-19: a systematic review and meta-analysis

Antiretrovirals for prophylaxis against COVID-19: a comprehensive literature review

Immune deficiency is a risk factor for severe COVID-19 in people living with HIV

An open-label randomized controlled trial of the effect of lopinavir/ritonavir, lopinavir/ritonavir plus IFN-b-1a and hydroxychloroquine in hospitalized patients with COVID-19

Lopinavir/ ritonavir for COVID-19: a systematic review and meta-analysis

The protease inhibitor lopinavir, boosted with ritonavir, as treatment for COVID-19: a rapid review

Lopinavir/ ritonavir and darunavir/cobicistat in hospitalized COVID-19 patients: findings from the multicenter Italian CORIST study

Interim Guidance for COVID-19 and Persons with HIV

Guidelines for the Use of Antiretroviral Agents in Adults and Adolescent with HIV

HIV and COVID-19: review of clinical course and outcomes HIV Research & Clinical Practice