The incidence and severity of coronavirus disease 2019 (COVID-19) among HIV-positive persons receiving antiretroviral therapy (ART) haven’t been characterized in large populations.

The penetration of antiretroviral drugs into the lung and other tissues has been shown for tenofovir in animal models and tenofovir, FTC, 3TC, and efavirenz in humans.

In line with the greater all-cause mortality of HIV-positive persons compared with the overall Spanish population, we found greater age- and sex-standardized mortality from COVID-19 in HIV-positive persons than within the general population. This comparison, however, isn’t straightforward, because biological age in persons with long-standing HIV infection is estimated to be 5 to 10 years greater than chronologic age, because the results of chronic immune activation by persistent gut microbial translocation, sustained chronic antigen stimulation, and co-infection by other pathogens. Although reporting delays aren’t expected for the HIV-positive persons in our study, the danger for COVID-19 diagnosis was lower within the HIV-positive population than within the general population.

This risk was noticeably lower among HIV-positive persons receiving TDF/FTC. Our results suggest that the danger for COVID-19 diagnosis isn’t higher in HIV-positive persons than within the general population in which HIV-positive patients receiving TDF/FTC had a lower risk for COVID-19 and related hospitalization than other HIV-positive persons.

These findings warrant further investigation in studies of HIV preexposure prophylaxis and randomized trials for the treatment and prevention of COVID-19 in persons without HIV.

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