HIV and SARS-CoV-2 Co-infection: A Systematic Review of the Literature and Challenges

Objectives The concurrence of infection with human immunodeficiency virus (HIV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, presents an intriguing problem with many uncertainties underlying their pathogenesis Despite over a 96 2 million cases of COVID-19 worldwide as of January 22nd, 2021, reports of patients co-infected with HIV and SARS-CoV-2 are scarce It remains unknown whether HIV patients are at a greater risk of infection from SARS-CoV-2, despite the immunocompromised status We present a systematic review of the literature reporting cases of HIV and SARS-CoV-2 co-infection and examine trends of clinical outcomes among co-infected patients Methods We systematically compiled 63 reports of HIV-1 and SARS-CoV-2 co-infection, published as of January 22nd, 2021 These studies were retrieved through targeted search terms applied to PubMed/Medline and manual search Results Despite scattered evidence, reports indicate a favorable prognosis for HIV patients with strict adherence to cART However, the presence of comorbidities was associated with a poorer prognosis in HIV/SARS-CoV-2 patients, despite cART and viral suppression Studies were limited by geographic coverage, small sample size, lack of patient details, and short follow-up durations Conclusions Although some anti-HIV drugs have shown promising in vitro activity against SARS-CoV-2, there is no conclusive evidence of the clinical efficacy of any anti-HIV drug in the treatment of COVID-19 Further research is needed to explain the underrepresentation of severe COVID-19 cases among the HIV patient population and to explore the possible protective mechanisms of cART in this vulnerable population