Is HIV associated with higher risk of severe COVID-19? Reflections on Africa.
Is HIV associated with higher risk of severe COVID-19? Reflections on Africa.
Africa remains an important case study in order to test if scientific theories are correct. Our assumption is that severe COVID-19 is directly caused by the viral infection leading to damage in the lungs and other organs. The lung damage can lead to respiratory failure and death, even with access to ICU for some patients.
Human Immunodeficiency Virus (HIV) is primarily a sexually transmitted virus that damages immune cells, making it difficult to fight against infections. In the late stages of HIV, immune depletion can lead to Acquired Immunodeficiency Syndrome (AIDS) which represents a major risk for all infections. Should this risk of severe infection be the same for COVID-19?
Why would HIV not be associated with a significantly higher risk of death?
My research has always been focused on severe COVID-19 being a viral mediated autoimmune disease. This means that the cause of damage to lungs is mainly through an overactive immune system “cytokine storm” triggered by the viral infection. It presumes that individuals on immunosuppression or with a poor immune system should not be at much higher risk of severe disease.
The primary risk factors for severe COVID-19 remain diabetes, obesity, male sex and cardiometabolic disease. HIV unsurprisingly (if you understand the link to autoimmunity in COVID-19), is not top of the list.
Mozambique COVID-19 paradox
Mozambique is one of the poorest African nations with the second highest HIV mortality in the world. Additionally, they had poor access to vaccines during the pandemic.
Taking into consideration that there are limited health resources with high prevalence of HIV and low vaccination rates, Mozambique should have been decimated by COVID-19.
The total population of Mozambique is just over 32 million people and they have over 1.6 million living with HIV. Yet, the total number of covid deaths is 2,224!
Mozambique is among the 10 countries with the highest HIV burden in the world, with a HIV prevalence of 13.2% in adults aged 15 to 49 years. Maputo City, the capital and largest city of Mozambique, has an even higher prevalence with 16.9% of the general population estimated to be infected.
Macicame, Ivalda, et al. "HIV prevalence and risk behavior among male and female adults screed for ennerolme0221682.ent into a vaccine preparedness study in Maputo, Mozambique." PLoS One 14.9 (2019):