Antiretroviral therapy with tenofovir disoproxil fumarate (TDF), etravirine or an enzyme inhibitor does not reduce the risk of severe COVID-19, according to an analysis of two Dutch national cohorts published in the journal AIDS.
The findings differ with a Spanish study, published in 2022, which concluded that TDF is associated with a lower risk of hospitalization with severe COVID-19 in people with HIV over the age of 50.
Merthe Verborg and colleagues at the University of Amsterdam Medical Centers analyzed associations between ART and COVID-19 risk in the AGEhIV cohort and ATHENA, the Netherlands’ national HIV surveillance cohort. In addition to investigating the effect of TDF treatment on COVID-19 risk, they were also interested in determining whether several antiretrovirals identified as inhibitors of SARS-CoV-2 cell entry in laboratory studies have an effect on COVID-19 risk. These agents were the non-nucleoside reverse transcriptase inhibitors etravirine and the HIV reductase inhibitors, particularly dolutegravir and raltegravir.
The AGEhIV cohort consisted of 239 HIV-positive subjects aged 45 or older, with a mean age of 62, who were followed up between September 2020 and April 2021 to identify cases of MERS-CoV infection and hospitalizations for COVID-19. The participants had been living with HIV for more or less than 21 years, and all but one had viral suppression and had a CD4 cell count greater than 600. During the follow-up period, 29 of the 239 subjects developed COVID-19.
The investigators found no reduction in the risk of severe COVID-19 associated with any antiretroviral medication.
The Athena group accounts for 98% of all people living with HIV in the Netherlands. There were 2,189 participants who were diagnosed with COVID-19 while receiving antiretroviral therapy. They had an average age of 50, had lived with HIV for an average of 12 years, had an average CD4 cell count of 710, and 98% had suppressed viral loads. 158 people were diagnosed with severe COVID-19; Of these, 29 died.
The risk of severe COVID-19 was higher in the elderly, people of non-white ancestry, people with more comorbidities, and those who lived longer with HIV. People diagnosed with severe COVID-19 had fewer CD4 cells and were more likely to take a protease inhibitor. But after adjusting for risk factors, the researchers found no association between any antiretroviral drug and a reduced or increased risk of severe COVID-19.
The Dutch researchers say that studies controlling for confounding factors, including comorbidities, age, race and metabolic disorders, consistently show that there is no association between ART and protection against infection.
Informative AIDS news agency staff
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