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Editorial for July 2021

WHO analysis reveals that HIV is a significant independent risk factor for severe COVID-19 illness at hospitalization and in-hospital death.

International AIDS Society (IAS) – calls upon all countries for people living with HIV to be included in priority populations for COVID-19 vaccine rollout. The studies highlighting new evidence on HIV and TB drug resistance updates on acceptability of HIV prevention tools and increased risk faced by women and girls under COVID-19 lockdowns.

The IAS featured five studies preview scientific highlights, showing important progress in HIV prevention, treatment and cure efforts despite major disruption to HIV programmes and research during the COVID-19 pandemic.

WHO study underscores the importance of countries including all people living with HIV in the list of priority populations for national COVID-19 vaccine programmes.

The global community must also do more to bring COVID-19 vaccines to countries around the world with high prevalence of HIV and other diseases. It is unacceptable that as of today, less than 3% of the entire African continent has received a single dose of the vaccine and less than 1.5% have received both doses.

The previous evidence regarding the impact of HIV infection on the severity and mortality of COVID-19 has been limited and sometimes conflicting, and most analyses have been based on relatively small cohorts of individuals in specific settings. In this report, WHO researchers analysed clinical data submitted to the WHO Global Clinical Platform for COVID-19 from 24 countries on more than 15,500 people living with HIV who were hospitalized for COVID-19.

A study highlights improved strategy to treat highly drug-resistant TB. The positive results from ZeNix, a Phase 3 trial seeking to improve a key treatment strategy for highly drug-resistant TB, could lead to changes in TB treatment guidelines and have real benefits for people living with TB. The study enrolled 181 people with highly drug-resistant TB in South Africa, Russia, Georgia and Moldova. A high relapse-free cure rate was observed in all study arms.

We will mark 100 years since the BCG vaccine for tuberculosis was first administered. This vaccine has saved many lives – but unfortunately, it has very limited effectiveness and it is still the only TB vaccine we have,” IAS 2021 Local Co-Chair Hendrik Streeck, director of the Institute of Virology and Professor of HIV Research at the University of Bonn in Germany, said.

This anniversary is a reminder of the urgent need for improved prevention and treatment options, including for highly drug-resistant TB.

The study from the Global Evaluation of Microbicide Sensitivity (GEMS) project found high rates of drug resistance in individuals who were diagnosed with HIV while participating in HIV pre-exposure prophylaxis (PreEP) rollout programmes. The project implemented drug resistance monitoring for PreEP users who were diagnosed with HIV.

Drug resistance in PreEP breakthrough infections could threaten treatment effectiveness, contribute to spread of resistance and undermine efforts to prevent HIV,” Prof Streeck said.

These findings reinforce the need for PreEP rollout programmes to check acute infections before starting people on PreEP and to conduct ongoing HIV drug resistance monitoring.

Another study observed promising adherence to oral PreEP and the dapivirine vaginal ring among adolescent girls and young women in Africa. The study assessed safety, adherence and acceptability of both products among adolescent girls and young women.

Acceptability varied, with about 88% liking the ring and about 64% liking oral PreEP. Only one HIV acquisition was reported among study participants. Both products were well tolerated and highly acceptable. “Adolescent girls and young women account for most of the new HIV infections in sub-Saharan Africa. These findings should accelerate efforts to make these two prevention options available to all those who can benefit,” Prof Kamarulzaman said.

A study also observed sexual violence and HIV exposure during COVID-19 lockdown. The research team concluded that investment in unhindered, flexible and adaptable gender-based violence mitigation is important during pandemics.

“There has been a lot of concern about the potential for COVID-19 lockdowns to fuel what UN women have called the ‘shadow pandemic’ of increased gender-based violence and unintended pregnancy. This study confirms that the HIV risk is also a major concern that should be taken into account when designing pandemic response plans.