Leveraging the advances in HIV for COVID-19
Authors: James H McMahon, Jennifer F Hoy, Adeeba Kamarulzaman, Linda-Gail Bekker, Chris Beyrer, Sharon R Lewin
Journal: The Lancet (2020)

The COVID-19 pandemic has led to accelerated research efforts globally and highlighted the importance of community engagement and leadership in the COVID-19 response. To achieve these objectives, partnerships between science, government, and affected communities are crucial, but building these rapidly presents major challenges. In the past months, we have also seen how advances in confronting the global HIV epidemic have had a positive impact on the COVID-19 response. Accessible, rapid point-of-care diagnostics were developed to increase uptake of HIV testing and shift to a model of self-testing and community-led programmes. These technologies are allowing for rapid implementation of diagnostic capacity for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR testing in low-income and middle-income countries (LMICs).1Loeffelholz MJ Alland D Butler-Wu SM et al.Multicenter evaluation of the Cepheid Xpert Xpress SARS-CoV-2 test.J Clin Microbiol. 2020; 128104426Google Scholar Strategies used to isolate and manufacture broadly neutralising antibodies for HIV have been applied to SARS-CoV-2 and are entering clinical trials.2Yang X Yu Y Xu J et al.Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study.Lancet Respir Med. 2020; 8: 475-481Summary Full Text Full Text PDF PubMed Scopus (6969) Google Scholar Although potential SARS-CoV-2 antivirals are still only in early stage research and development, eventually, combination antivirals might have a role for treatment and prevention of COVID-19, as pioneered for HIV.3Beigel JH Tomashek KM Dodd LE et al.Remdesivir for the treatment of Covid-19— preliminary report.N Engl J Med. 2020; (published online May 22.)https://doi.org/10.1056/NEJMoa2007764Crossref Scopus (4960) Google Scholar, 4Boulware DR Pullen MF Bangdiwala AS et al.A randomized trial of hydroxychloroquine as postexposure prophylaxis for Covid-19.N Engl J Med. 2020; 383: 517-525Crossref PubMed Scopus (965) Google Scholar Novel vaccine platforms, including nucleic acid-based vaccines such as DNA and RNA and live vectors, again developed for HIV, are now in phase 2 and 3 clinical trials for COVID-19.5Graham BS Rapid COVID-19 vaccine development.Science. 2020; 368: 945-946Crossref PubMed Scopus (519) Google Scholar, 6Folegatti PM Ewer KJ Aley PK et al.Safety and immunogenicity of the ChAdOx1 nCoV-19 vaccine against SARS-CoV-2: a preliminary report of a phase 1/2, single-blind, randomised controlled trial.Lancet. 2020; 396: 467-478Summary Full Text Full Text PDF PubMed Scopus (1752) Google Scholar, 7Jackson LA Anderson EJ Rouphael NG et al.An mRNA vaccine against SARS-CoV-2—preliminary report.N Engl J Med. 2020; (published online July 14.)https://doi.org/10.1056/NEJMoa2022483Crossref Scopus (2270) Google Scholar As with HIV, COVID-19 has had a major impact on women, with higher risks of infection for women in some settings, such as health care, and a disproportionate economic impact on women as a consequence of school closures and women being primary caregivers.8Wenham C Smith J Morgan R et al.COVID-19: the gendered impacts of the outbreak.Lancet. 2020; 395: 846-848Summary Full Text Full Text PDF PubMed Scopus (1081) Google Scholar Furthermore, given the high risk of infection and adverse outcomes from COVID-19 in Black and minority ethnic groups9Williamson EJ Walker AJ Bhaskaran K et al.OpenSAFELY: factors associated with COVID-19 death in 17 million patients.Nature. 2020; 584: 430-436Crossref PubMed Scopus (3955) Google Scholar and other vulnerable populations, the lessons of community empowerment and advocacy from HIV could help inform the response to COVID-19. Lessons learnt from scaling up antiretroviral therapy to more than 25 million people, including those with limited access to health care, and specifically to engage women will be applicable to rolling out any potential COVID-19 vaccines and treatments. If COVID-19 vaccines are eventually deployed, there are likely to be challenges with mass vaccination programmes but empowering marginalised groups and using a human rights approach will be central to success. The accelerated agenda of COVID-19 research will benefit the future of HIV testing, treatment, and prevention. There will be a continued expansion of the research infrastructure needed to work with both viruses, specifically high containment laboratories and animal facilities. Diagnostic, antiviral, and vaccine companies are involved in COVID-19 research, including companies that have not previously engaged in viral infectious disease.10Baum A Fulton BO Wloga E et al.Antibody cocktail to SARS-CoV-2 spike protein prevents rapid mutational escape seen with individual antibodies.Science. 2020; (published online June 15.)https://doi.org/10.1126/science.abd0831Crossref Scopus (865) Google Scholar Given the scale of testing needed in the COVID-19 pandemic, the introduction of testing capabilities in LMICs could also be used for HIV and tuberculosis.1Loeffelholz MJ Alland D Butler-Wu SM et al.Multicenter evaluation of the Cepheid Xpert Xpress SARS-CoV-2 test.J Clin Microbiol. 2020; 128104426Google Scholar These overlapping epidemics represent an opportunity to extend cross-disciplinary research into the integrated service delivery for HIV, tuberculosis, and COVID-19, and aim to achieve sustained benefits of prevention and treatment.11Bekker LG Alleyne G Baral S et al.Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society–Lancet Commission.Lancet. 2018; 392: 312-358Summary Full Text Full Text PDF PubMed Scopus (205) Google Scholar Finally, the accelerated pathways to develop COVID-19 vaccines resulting in clinical trials of multiple candidates within months of discovery of SARS-CoV-2 should be applied to challenges such as developing an HIV vaccine. In the short term, there have been some adverse impacts of COVID-19 on HIV research and services, as for many other diseases. Nearly all HIV clinical trials globally have halted or slowed enrolment to appropriately maximise safety for participants, and health services have seen reductions in screening, laboratory monitoring, and collections of medications, highlighting the fragility of health systems, especially in LMICs. Many HIV-focused laboratory-based research groups have moved to work on SARS-CoV-2. Finally, a decrease in resourcing for infectious diseases research, together with the economic impacts of COVID-19, could lead to less funding for HIV research and ongoing disruption of the provision of HIV and related services.12Jewell BL Mudimu E Stover J et al.Potential effects of disruption to HIV programmes in sub-Saharan Africa caused by COVID-19: results from multiple mathematical models.Lancet HIV. 2020; 7: e629-e640Summary Full Text Full Text PDF PubMed Scopus (250) Google Scholar Yet the transformative advances that are being achieved in the response to COVID-19 could be harnessed to establish strategic and strong collaborations for the HIV and COVID-19 scientific communities. The International AIDS Society (IAS) achieved this at the virtual IAS COVID-19 Conference in July, 2020. A similar format will be used in future conferences related to HIV prevention and COVID-19 vaccines, such as the HIV Research for Prevention Conference in early 2021. Incentives are also needed for the public, private, and philanthropic sectors to maintain their interest and leadership in developing solutions for infectious diseases, not only during a pandemic but also during interpandemic periods. Finally, we should ensure that the global health alliances that are currently forming in relation to COVID-19 vaccines, such as the COVID-19 Vaccine Global Access Facility, are maintained to deliver solutions to ongoing global health challenges. International solidarity and collaboration have been the hallmarks of the HIV response globally. We will need even more widespread collaborative efforts to end the COVID-19 pandemic. Concerns about access to potential COVID-19 vaccines and therapeutics are highly relevant for LMICs and for vulnerable populations globally.13Yamey G Schäferhoff M Hatchett R Pate M Zhao F Kennedy McDade K Ensuring global access to COVID-19 vaccines.Lancet. 2020; 395: 1405-1406Summary Full Text Full Text PDF PubMed Scopus (179) Google Scholar Arguably, the most important lesson of the HIV response is that no country could go it alone in bringing this deadly virus to its current state of a chronic treatable condition. We need to heed this lesson to avoid nationalistic responses that jeopardise global access to solutions and cannot succeed against a global pandemic. JHM reports that his institution had received funding to conduct clinical trials from Gilead Sciences, ViiV Healthcare, Merck Sharp & Dohme Australia. JFH reports personal fees paid to her institution from Gilead Sciences, ViiV Healthcare, and Merck Sharp & Dohme Australia. SRL reports grants from the National Health and Medical Research Council of Australia, the National Institutes of Health; American Foundation for AIDS Research, Gilead Sciences, Merck, ViiV, Leidos, the Wellcome Trust, Australian Centre for HIV and Hepatitis Virology Research, Melbourne HIV Cure Consortium, Department of Health and Human Services, and the Medical Research Future Fund. AK, L-GB, and CB declare no competing interests.