Department of Infection and Immunity, Blizzard Institute, Queen Mary University of London.
Royal London Hospital, Barts Health NHS Trust, London.
Curr Opin Infect Dis. 2023 Feb 1;36(1):20-25. doi: 10.1097/QCO.0000000000000898. Epub 2022 Dec 8.
The COVID-19 pandemic and public health response have directly and indirectly affected broader health outcomes, especially for those with existing chronic conditions, including HIV. We examine our current understanding of the global impact of COVID-19 on people with HIV (PWH).
The interaction between COVID-19 and HIV is complex, making it challenging to estimate its true impact on PWH. Evidence to date does not suggest that HIV confers a higher risk of acquiring SARS-CoV-2. However, once acquired, HIV increases the risk of severe COVID-19 and mortality, particularly in immunosuppressed viraemic individuals and in the context of traditional COVID-19 risk factors, including disparities in social determinants of health. In addition, COVID-19 vaccines may be less effective in the context of HIV infection with additional doses needed. The consequences of disruption of access to essential prevention and treatment services because of the pandemic are becoming evident and will likely adversely affect outcomes, risking decades of progress.
Given the increased mortality risk and reduced vaccine effectiveness seen in PWH, specific prevention and support measures are needed, including prioritization of vaccination and boosters, funding to mitigate the impact of pandemic and enabling integrated healthcare delivery during pandemics will be critical.
目的综述:COVID-19 大流行和公共卫生应对措施直接和间接地影响了更广泛的健康结果,特别是对那些患有现有慢性疾病(包括 HIV)的人。我们考察了目前对 COVID-19 对 HIV 感染者(PWH)的全球影响的理解。
最新发现:COVID-19 和 HIV 之间的相互作用很复杂,因此很难估计其对 PWH 的真正影响。迄今为止的证据表明,HIV 不会增加感染 SARS-CoV-2 的风险。然而,一旦感染,HIV 会增加罹患严重 COVID-19 和死亡的风险,特别是在免疫抑制的病毒血症个体中,以及在传统的 COVID-19 风险因素(包括健康决定因素的社会差异)背景下。此外,在 HIV 感染的情况下,COVID-19 疫苗的效果可能较差,需要额外的剂量。由于大流行而导致获得基本预防和治疗服务的机会受到干扰的后果正在显现,这可能会对结果产生不利影响,使几十年的进展面临风险。
总结:鉴于 PWH 中观察到的死亡率增加和疫苗效力降低,需要采取具体的预防和支持措施,包括优先接种疫苗和加强针、提供资金以减轻大流行的影响,并在大流行期间实现综合医疗服务的提供,这些都至关重要。