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primary care network: a cross-sectional study. Lancet Infect Dis. 2020 Sep;20(9):10341042. PubMed: https://pubmed.gov/32422204. Full-text: https://doi.org/10.1016/S14733099(20)30371-6 Lippi G, Henry BM. Active smoking is not associated with severity of coronavirus disease 2019 (COVID-19). Eur J Intern Med. 2020 Mar 16. PubMed: https://pubmed.gov/32192856. Full-text: https://doi.org/10.1016/j.ejim.2020.03.014 Smith JC, Sausville EL, Girish V, et al. Cigarette Smoke Exposure and Inflammatory Signaling Increase the Expression of the SARS-CoV-2 Receptor ACE2 in the Respiratory Tract. Dev Cell. 2020 Jun 8;53(5):514-529.e3. PubMed: https://pubmed.gov/32425701. Full-text: https://doi.org/10.1016/j.devcel.2020.05.012
HIV infection HIV infection is of particular interest in the current crisis. First, many patients take antiretroviral therapies that are thought to have some effect against SARS-CoV-2. Second, HIV serves as a model of cellular immune deficiency. Third, and by far the most important point, the collateral damage caused by COVID-19 in the HIV population may be much higher than that of COVID-19 itself. Preliminary data suggest no elevated incidence of COVID-19. In 5700 patients from New York, only 43 (0,8%) were found to be HIV-positive (Richardson 2020). In Barcelona, the standardized incidence rate was lower in persons living with HIV (PLWH) than in the general population (Inciarte 2020). Given the fact that HIV+ patients may be at higher risk for other infectious diseases such as STDs, these percentages were so low that some experts have already speculated on potential “protective” factors (i.e., antiviral therapies or immune activation). Moreover, a defective cellular immunity could paradoxically be protective for severe cytokine dysregulation, preventing the cytokine storm seen in severe COVID-19 cases. Appropriately powered and designed studies are still needed to draw conclusions on the effect of COVID-19. In our own retrospective analysis of 33 confirmed SARS-CoV-2 infections between March 11 and April 17 in 12 participating German HIV centers, no excess morbidity or mortality was revealed (Haerter 2020). However, a multicenter cohort study which evaluated risk factors for morbidity and mortality of COVID‐19 in PLWH infected with SARS‐CoV‐2 in three countries, patients with severe COVID‐19 had a lower current CD4 T cell count and a lower CD4 T cell nadir, compared with patients with mild‐to‐moderate COVID‐19 (Hoffmann 2020). In a multivariate analysis, the only factor associated with risk for severe COVID‐19 was a current CD4+ T cell count of < 350/µl (adjusted odds ratio 2,85, 95% CI: 1,26‐6,44, p = 0,01). The only factor associ-ated with mortality was a low CD4 T cell nadir. In a large population study from South Africa, HIV was independently associated with increased COVID-19 mortality, COVID Reference ENG 006.9
