Dangerous liaisons? The role of inflammation and comorbidities in HIV and SARS-CoV-2 infection

ABSTRACT

Introduction

In people living with HIV (PLWH), immune activation and inflammation levels are high even when viral suppression is maintained, potentially contributing to several comorbidities, and hampering the immune response to infections such as the recent SARS-CoV-2 disease 2019 (COVID-19).

Areas covered

Immune activation and inflammation play a role in SARS-CoV-2 infection. Severe COVID-19 patients may experience cytokine release syndrome (CRS), leading to alveolar damage, pulmonary fibrinolysis, dysregulated coagulation, and pulmonary injury. Into the systemic circulation, cytokines in excess might leak out of pulmonary circulation, causing systemic symptoms and possibly a multiple-organ dysfunction syndrome. Preexisting comorbidities are also linked to worse COVID-19 outcome: studies suggest that diabetes and hypertension are linked to higher mortality rates. Such comorbidities are more frequent in PLWH, but it is unclear if they have worse outcomes in the case of COVID-19. The literature was searched in PubMed/MEDLINE and EMBASE, and manually in COVID-19 resources.

Expert opinion

A body of evidence shows that HIV and SARS-CoV-2 are able to activate inflammatory pathways, acute in the case of SARS-CoV-2, chronic in the case of HIV, while the comorbidities seem to represent, in the first case, a contributory cause, in the second an effect of the virus-induced damage.

KEYWORDS:

• Comorbidity
• hiv
• immune response
• inflammation
• SARS-CoV-2

Article highlights

• HIV and SARS-CoV-2 can both activate inflammatory pathways

• Cytokine release syndrome (CRS) might occur in severe COVID-19 patients and represents a negative prognostic factor for survival

• Treatment for CRS seems less effective in presence of hyperglycemia, both in diabetic and non-diabetic subjects

• SARS-CoV-2 disease has a worse outcome in subjects with concurrent diabetes, hypertension and coagulation disorders

• Cardiovascular comorbidities are frequent among persons living with HIV, suggesting that COVID-19 may have a worse outcome than in HIV-negative people

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.