Rapid Response Research Awards on COVID-19 and HIV Recipients

As of May 15, the number of confirmed worldwide cases of coronavirus disease 2019 (COVID-19) has exceeded four million cases with more than 300,000 deaths. Several reports showed the presence of organ impairments including lung and kidney damage are linked to the worsening death rates. Disease states such as high blood sugar, high blood pressure, advanced age, and male gender have been shown as risk factors. Surprisingly, human immunodeficiency virus (HIV) infection has not been linked as a risk factor or death. A recent report from New York City, an epicenter for both HIV infection and SARS-CoV-2, showed only 0.8% of HIV-infected patients with COVID-19represented in the study. The underrepresentation of PLWH from previous reports is concerning. We have little to no information on this finding on how HIV patients would react to COVID19. In the proposed study, we will conduct an observational study on PLWH with COVID-19, collecting patients’ characteristics, outcomes, and determining the predictors associated with outcomes at the two major teaching hospitals in the District of Columbia.

In Washington, DC, Latinxs are profoundly affected and experiencing multiple risks associated with the COVID-19 pandemic as well as the HIV epidemic. This pilot project on COVID-19 and HIV will be using data from interviews to explore the impact of the COVID-19 pandemic on HIV prevention and care services for Latinx sexual minority men and transgender women in Washington DC. The results of this project can assist those who provide health care to the Latinx community, as well as Latinxs who might be at risk for COVID-19 and HIV.  Throughout the project, the project team will work closely with the DC CFAR Community Advisory Board and other community stakeholders as we plan how to reach out to the community, design of interview questions, interpretation of findings, and how to share what we learn with the larger community appropriately. An initial plan for sharing the results includes post/present findings online, particularly in online platforms where recruitment took place; share findings with community partners, making presentations when requested; and hold public discussion sessions to review and discuss findings.

CDC informs that people aged 65 and older, people with poor controlled HIV or AIDS may be at higher risk of COVID-19.  However, severe lack of information makes policy implementation at community level a challenging task. DC with a HIV prevention rate of 1.8% and 55% of the people living with HIV (PLWH) being 50 years and older is facing a serious threat that needs immediate attention. This proposed study has the potential to make substantial impact by identifying emerging hotspots of PLWH who are coinfected with COVID-19 (coinfections) and compare it with people who are diagnosed with COVID-19 (mono-infections). Emerging hotspots will be identified at block-level in comparison with persistent hotspot and oscillating hotspots will add immense value in planning mitigation strategies including increased testing. Considering people with lower viral suppression are more susceptible to COVID-19, the proposed study with find spatial clusters (hotspots) of poor viral suppression and its association with COVID-19 in DC, controlling for demographic characteristics.  Finally, considering strategies such as stay-home, isolation, social distancing, and phased opening is changing over time, it is imperative to understand the implications of such strategies on coinfections and mono-infections (outcomes).  We propose to use time based analysis to find the consequences of these strategies on the outcomes across communities in DC.

The purpose of this study is to understand the clinical course of COVID-19 infection among people who have HIV. We aim to use our unique location and patient population to contribute to the small but growing body of literature on this subject. To date, little is known about COVID-19 in HIV patients, and most of the information comes from descriptions of individual patients or series of a few patients in other countries. Other publications have focused on the social impact of COVID-19 on people living with HIV and outlined hypotheses on how this population might be affected. Some posit that HIV as an immunocompromised state puts patients at higher risk for severe illness with COVID-19, while others propose that it may actually offer some protection against the devastating inflammation seen in this disease13, 14. Despite conflicting theories, many organizations such as the CDC have classified people living with HIV as being at higher risk for serious illness or death from COVID-19. People with HIV and their physicians need more information about how COVID-19 affects them, in order to flag signs of severe infection early and take appropriate action.

 This background is the basis of our research questions and hypothesis: How severe is the presentation of COVID-19 in people with HIV living in Washington, DC? Does a person’s medical history, the specifics of their HIV course (including virus level and immune cell count), or medications including antiretrovirals, affect how severe the course of COVID-19 is for them and how long the disease lasts? If people with HIV experience more severe illness from COVID-19, then they must receive priority for treatment and prevention strategies (such as a vaccine) once those become available. If on the other hand they have the same risk for severe COVID-19 as the general population, or lower, then there is no benefit to singling them out during this pandemic.