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At the beginning of the Covid-19 pandemic, many doctors specialized in HIV / AIDS feared that the new virus would especially affect their patients, both due to their comorbidities and the fact that many are over 50 years old. However, the clinical reality has denied it and now a study also does.

In a study carried out in 60 hospitals throughout Spain, which has been published in the Annals of Internal Medicine, it is observed that people with HIV have no greater risk than the general population of becoming infected with the coronavirus or suffering from its disease, the Covid-19 .

In the research, coordinated by the director of the National AIDS Plan, Julia del Amo, the risk of diagnosis, hospitalization, ICU admission and mortality of 77,590 HIV-infected patients on antiretroviral treatment was analyzed. Of these, 236 were diagnosed with Covid-19 disease; 151 were hospitalized; 15 were admitted to the ICU, and 20 died.

But the research leaves another striking finding: HIV patients who were being treated with the antiretroviral drugs tenofovir difumarate / emtricitabine (TDF / FTC) are those who have the lowest risk of infection and hospitalization for the coronavirus , compared to those receiving other treatments. for HIV / AIDS.

Due to the limitations in the design of this study, points out one of its authors José Ramón Arribas, head of the Infectious Diseases Service at Hospital La Paz-Carlos III (Madrid), it cannot be concluded at all that treatment with TDF / FTC is the cause of a lower incidence of Covid-19.

It should be borne in mind that TDF is administered "in HIV patients without comorbidities , such as hypertension or renal failure", which in turn are susceptibility factors for covidic disease. In fact, it is more common to use another formulation of tenofovir, tenofovir alafenamide (TAF), due to its lesser adverse effects on kidney and bone.

In this, the researcher of this work, Juan Antonio Pineda, specialist of the Infectious Diseases and Microbiology Unit of the Hospital Universitario de Valme (Seville), abounds, for whom "specific studies are necessary to analyze whether treatment with TDF / FTC effectively reduces the risk of coronavirus " or if it could be that when administered to younger HIV patients, it is found in a population where more asymptomatic infections or mild forms of Covid-19 occur.

However, the hypothesis is on the table, and is also supported by experimental work. "There is some biological basis that indicates that tenofovir may be effective. Some simulation studies and computer models indicate that the structure of this drug may inhibit SARS-CoV-2 polymerase; there is also a model of coronavirus infection in ferrets where an improvement has been seen when the animals receive TDF / FTC, "says Arribas. In addition, "some immunomodulatory effect, which perhaps would be beneficial in avoiding cytokine storm" of severe Covid-19 has been observed, without leaving the experimental arena. On the other hand, TDF, unlike the TAF formulation, appears at especially high levels in blood and may therefore be more active against SARS-CoV-2.

This preventive effect of antiretroviral treatment against Covid-19 is being investigated precisely in the EPICOS study (Clinical Trial for the Prevention of Coronavirus Infection in Healthcare), also promoted by the National Plan on AIDS. This work analyzes whether TDF / FTC, among other branches of antiviral drugs, can prevent symptomatic COVID-19 disease in high-risk healthcare personnel. The study is carried out in 67 hospitals in 14 autonomous communities and has the participation of 4,000 professionals .

CoRIS cohort

Many of the authors who have participated in the study of the National AIDS Plan that has just been published are also part of the project "Covid-19 infection in HIV-infected patients", which uses data from the Research Network Cohort in AIDS (CoRIS).

The CoRIS cohort is made up of patients with HIV , who have been followed prospectively since 2004, in more than 40 hospital centers and with samples periodically filed at the BioBank of the University Hospital Gregorio Marañón, in Madrid.

One of the big questions from which this study starts, recalls the main researcher of the project Juan Berenguer, from the Infectious Diseases Service of the Gregorio Marañón Hospital, is what factors influence the low proportion of people with HIV among people hospitalized by Covid- 19 . "We estimate that in Spain only seven out of every thousand patients who have been admitted have HIV infection as a base disease."

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