{"doi":"10.1002/jmv.26416","title":"COVID‐19 and AIDS: Outcomes from the coexistence of two global pandemics and the importance of chronic antiretroviral therapy","abstract":"The outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome 2 (SARS-CoV-2), has created a worldwide pandemic, raising multitude of challenges and uncertainties regarding disease management specific to immunocompromised patient populations.1 Despite over ~16 million confirmed cases of COVID-19 worldwide as of July 25, 2020, there is a dearth of reports describing the co-infection of human immunodeficiency virus (HIV) and SARS-CoV-2.2 There are various unknowns regarding the simultaneous impact from these two diseases, despite the fact that the majority of patients with acquired immunodeficiency syndrome (AIDS) are immunocompromised and have comorbidities, which can predispose them to severe clinical symptoms, and poorer prognosis, from COVID-19.3, 4 A large majority of reports indicate that HIV patients with normal CD4 T-cell counts and suppressed viral loads and receiving regular, combined antiretroviral therapy (cART) do not present with a severe clinical course of COVID-19 and may not be at an increased risk of developing SARS-CoV-2 infection.5-9 These favorable indications for HIV patients may be the byproduct of a potential protective factor conferred by antiretroviral therapy, which has also been used successfully in previous coronavirus epidemics.10, 11 SARS-CoV-2 and HIV carry numerous similarities as they are both RNA viruses capable of undergoing mutations and recombination under selection pressure within the host.12 During the previous SARS-CoV epidemic, the HIV-1 protease inhibitor nelfinavir was found to strongly inhibit the cytopathic effect induced by SARS-CoV infection.10 Lopinavir was also found to show efficacy both in vivo and in vitro, reducing viral titers and shortening disease progression in case of MERS-CoV-infected animals.11 HIV-1 protease inhibitors including lopinavir/ritonavir and darunavir have been found as efficacious treatment options in patients coinfected with COVID-19 and HIV by reducing SARS-CoV-2 viral loads and accelerating recovery.13-15 However, recently, remdesivir, a broad-spectrum antiviral drug, has also shown promising results in suppressing SARS-CoV-2 replication in a double-blind, randomized, placebo-controlled trial, where adults hospitalized with COVID-19 that received remdesivir showed reduced respiratory tract involvement.16 Similarly, tenofovir has also been found to be highly efficacious against SARS-CoV-2 through potently inhibiting SARS-CoV-2 RNA-dependent RNA polymerase.17 However, it is important to recognize that clinical evidence regarding the role of antiretroviral therapy, specifically, lopinavir/ritonavir is still emerging. The current COVID-19 treatment guidelines issued by the NIH recommend against the use of lopinavir/ritonavir protease inhibitors (AIII) for the treatment of COVID-19, and is restricted to clinical trials.18, 19 Various large clinical case series have corroborated the growing evidence that patients with HIV/SARS-CoV-2 co-infection do not have excess morbidity and mortality when compared to non-HIV COVID-19 patients. In a study of 47 coinfected patients reported by Gervasoni et al,9 HIV patients that were hospitalized with SARS-CoV-2 infection generally had favorable outcomes and did not experience severe symptoms requiring intensive care unit admission or mechanical ventilation. Another study by Blanco et al13 reporting 5 patients coinfected with HIV/SARS-CoV-2 in Spain, showed that patients who were previously receiving ART before admission for COVID-19 experienced less severe symptoms, which did not require intensive care unit admission or mechanical ventilation. Härter et al5 reported similar outcomes in a study of 33 HIV patients infected with SARS-CoV-2 who were all on antiretroviral therapy at the time of COVID-19 diagnosis. This study also did not support excess mortality and morbidity among HIV patients with COVID-19 when patients were virally suppressed on antiretroviral therapy. Finally, Shalev et al ","journal":"Journal of Medical Virology","year":2020,"id":79632,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":16,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9569,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":296005,"name":"Arpan Acharya","orcid":"0000-0003-2721-1062","position":1,"is_corresponding":false},{"id":296006,"name":"Mahesh Mohan","orcid":"0000-0003-4360-3277","position":2,"is_corresponding":false},{"id":69434,"name":"Siddappa N. Byrareddy","orcid":"0000-0002-6889-4640","position":3,"is_corresponding":false},{"id":413638,"name":"Raj H. Patel","orcid":"0000-0003-1896-1961","position":0,"is_corresponding":true}],"reference_count":22,"raw_metadata":null,"created_at":"2026-07-18T21:50:57.971597Z","pmid":"32779740","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}