Incidence and Severity of COVID-19 in HIV-Positive Persons Receiving Antiretroviral Therapy
Authors: Julia del Amo, Rosa Polo, Santiago Moreno, Asunción Díaz, Esteban Martínez, José Ramón Arribas, Inma Jarrín, Miguel A. Hernán
Journal: Annals of Internal Medicine (2021)

LettersApril 2021Incidence and Severity of COVID-19 in HIV-Positive Persons Receiving Antiretroviral TherapyFREEJulia del Amo, MD, PhD, Rosa Polo, MD, PhD, Santiago Moreno, MD, PhD, Asunción Díaz, MD, PhD, Esteban Martínez, MD, PhD, José Ramón Arribas, MD, PhD, Inma Jarrín, PhD, Miguel A. Hernán, MD, DrPHJulia del Amo, MD, PhDMinistry of Health, Madrid, Spain, Rosa Polo, MD, PhDMinistry of Health, Madrid, Spain, Santiago Moreno, MD, PhDUniversity Hospital Ramón y Cajal and HIV Network of Excellence, Madrid, Spain, Asunción Díaz, MD, PhDInstitute of Health Carlos III, Ministry of Health, and HIV Network of Excellence, Madrid, Spain, Esteban Martínez, MD, PhDUniversity Hospital Clinic, Barcelona, Spain, and HIV Network of Excellence, Madrid, Spain, José Ramón Arribas, MD, PhDUniversity Hospital La Paz, IdiPAZ, and HIV Network of Excellence, Madrid, Spain, Inma Jarrín, PhDInstitute of Health Carlos III and HIV Network of Excellence, Madrid, Spain, Miguel A. Hernán, MD, DrPHHarvard T.H. Chan School of Public Health and Harvard–MIT Division of Health Sciences and Technology, Boston, MassachusettsAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-1399 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE: We thank Dr. Titanji and colleagues for their thoughtful comments about our article. We did not have individual data on comorbidities and thus could not adjust for them. In a recent publication (1), we reported 3 sensitivity analyses exploring the possible effect of confounding by comorbidities. Those findings suggest that confounding by individual clinical characteristics cannot completely explain the lower risk for COVID-19 diagnosis and hospitalization among HIV-positive persons receiving TDF/FTC. A recent analysis from South Africa (2) also found a lower risk for COVID-19 death among HIV-positive persons receiving TDF/FTC after adjustment for kidney disease and HIV viral suppression.We share Dr. Titanji and colleagues' concerns that overinterpretation of research findings may lead to inappropriate off-label use of drugs. To exclude the possibility of confounding, we are currently conducting a randomized, placebo-controlled, clinical trial (EPICOS [Randomized Clinical Trial for the Prevention of SARS-CoV-2 Infection in Healthcare Personnel]) (3) to estimate the efficacy of TDF/FTC and hydroxychloroquine as preexposure prophylaxis for COVID-19 among health care workers.References1. Del Amo J, Polo R, Moreno S, et al.. Antiretrovirals and risk of COVID-19 diagnosis and hospitalization in HIV-positive persons. Epidemiology. 2020;31:e49-51. [PMID: 32773469] doi: 10.1097/EDE.0000000000001235 CrossrefMedlineGoogle Scholar2. Boulle A, Davies MA, Hussey H, et al. Risk factors for COVID-19 death in a population cohort study from the Western Cape Province, South Africa. Clin Infect Dis. 2020. [PMID: 32860699] doi: 10.1093/cid/ciaa1198 Google Scholar3. Randomized clinical trial for the prevention of SARS-CoV-2 infection (COVID-19) in healthcare personnel (EPICOS) [clinical trial]. Accessed at https://clinicaltrials.gov/ct2/show/NCT04334928 on 2 April 2020. Google Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Julia del Amo, MD, PhD; Rosa Polo, MD, PhD; Santiago Moreno, MD, PhD; Asunción Díaz, MD, PhD; Esteban Martínez, MD, PhD; José Ramón Arribas, MD, PhD; Inma Jarrín, PhD; Miguel A. Hernán, MD, DrPHAffiliations: Ministry of Health, Madrid, SpainUniversity Hospital Ramón y Cajal and HIV Network of Excellence, Madrid, SpainInstitute of Health Carlos III, Ministry of Health, and HIV Network of Excellence, Madrid, SpainUniversity Hospital Clinic, Barcelona, Spain, and HIV Network of Excellence, Madrid, SpainUniversity Hospital La Paz, IdiPAZ, and HIV Network of Excellence, Madrid, SpainInstitute of Health Carlos III and HIV Network of Excellence, Madrid, SpainHarvard T.H. Chan School of Public Health and Harvard–MIT Division of Health Sciences and Technology, Boston, MassachusettsDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-3689. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoIncidence and Severity of COVID-19 in HIV-Positive Persons Receiving Antiretroviral Therapy Julia del Amo , Rosa Polo , Santiago Moreno , Asunción Díaz , Esteban Martínez , José Ramón Arribas , Inma Jarrín , and Miguel A. Hernán , and for The Spanish HIV/COVID-19 Collaboration* Incidence and Severity of COVID-19 in HIV-Positive Persons Receiving Antiretroviral Therapy Boghuma Titanji , Alfonso C. Hernandez-Romieu , Max W. 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