The Covid-19 pandemic has unfolded against a backdrop of a substantial global HIV pandemic, particularly in Africa which accounts for 2 in every 3 people living with HIV in the world. Early predictions of how these two pandemics would collide raised concerns that people living with HIV, particularly those with low CD4 T-cell counts, would be at higher risk of developing severe Covid-19. Fortunately, the doomsday scenarios from the models did not become a reality. However, SARS-CoV-2 infection in people living with HIV raises some concerns at three levels - at health systems, clinical and virological / immunological levels.
At a health system's level, the AIDS response has facilitated the Covid-19 response in several countries. Key resources used for control of HIV, including: diagnostic platforms, community outreach, programs, medical care access, and research infrastructure, were redirected to control Covid-19. However, the AIDS response was negatively impacted by the national lockdowns instituted early in the Covid-19 pandemic. This resulted in a significant decrease in health care attendance by patients with HIV, potentially reversing the gains made over the past two decades. HIV testing was deferred by many patients delaying diagnosis and initiation of ART.
A significant concern though is persistent SARS-CoV-2 infection in severely immunocompromised HIV patients, leading to the creating of new viral variants that potentially escape natural and vaccine-induced immunity. The latter may be particularly important in HIV patients who do not respond adequately to Covid-19 vaccines.
There are important lessons from the past 40 years of the HIV response that may benefit the Covid-19 response. Both pandemics have provided a new lens for the nexus between science, policy-making and global health in pursing the sustainable development goals, with equity and social justice as guiding principles.

 

Quarraisha Abdool Karim, PhD is a South African infectious diseases epidemiologist who has made pioneering contributions over the past 34 years to preventing HIV in adolescent girls and young women. She is co-Founder and Associate Scientific Director of CAPRISA, Professor in Clinical Epidemiology, Columbia University and Pro-Vice Chancellor for African Health, University of KwaZulu-Natal. She serves as UNAIDS Special Ambassador for Adolescents and HIV and is Co-Chair of the UN SDG 10 Member Technical Facilitation Mechanism. She led the landmark CAPRISA 004 trial that first demonstrated that antiretrovirals can prevent sexual transmission of HIV infection that laid the foundations for pre-exposure prophylaxis (PrEP). The TB-HIV treatment trials that she co-led have impacted WHO treatment guidelines.
The Fogarty AIDS Training Programme she led trained over 600 African scientists strengthening infectious disease research capacity in the region. She is a strong advocate for the rights of people living with, and affected, by HIV.
She has received the highest awards of Canada (Gairdner), France (Christophe Merieux) and Vietnam (Vinfuture). She is a past Vice-President of the African Academy of Science and a Fellow of The World Academy of Science, Royal Society of South Africa, Academy of Science of South Africa and a member of the US National Academy of Medicine.

 

Salim S. Abdool Karim, FRS, is a South African clinical infectious diseases epidemiologist widely recognized for scientific contributions and leadership in AIDS and Covid-19.  He is Director of the Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, and CAPRISA Professor of Global Health at Columbia University, New York. He is adjunct Professor of Immunology and Infectious Diseases at Harvard University, adjunct Professor of Medicine at Cornell University and Pro Vice-Chancellor (Research) at the University of KwaZulu-Natal. He previously served as President of the South African Medical Research Council.
He is a Commissioner on both the African Union Commission on Covid-19 and the Lancet Commission on Covid-19. He is a member of the WHO TB-HIV Task Force. He is a member of the Science Council of the WHO and Vice-President of the International Science Council. He serves on the Boards of the New England Journal of Medicine, Lancet Global Health and Lancet HIV.  His many awards include the Gairdner Global Health Award and the Kwame Nkrumah Prize, the highest award for research in Africa. He is member of the US National Academy of Medicine and the American Academy of Microbiology. He is a Fellow of the Royal Society.