“HIV knocks out all the brakes on the immune system, and as a consequence you get this inflammatory response that is robust and persistent – and now you still have Covid,” said Dr. Steven Deeks, an HIV expert at the University of California, San Francisco. “I would be surprised if HIV wasn’t linked to the progression of Covid-19”.

Updated

July 15, 2021 at 11:58 a.m. ET

Dr. Deeks disagreed with the study researchers’ decision to adjust the calculations for the presence of other conditions such as obesity, as HIV infection itself can cause many of these diseases. “For 25 years we have argued that a history of HIV infection is an independent risk factor for the progression of heart disease, cancer and aging,” he said. Without this statistical adjustment, the increased risk of death for these patients would most likely have been higher than the 30 percent reported in the study.

Many previous studies had a bias that could have masked some of the risk: Doctors tend to hospitalize Covid-19 patients with HIV out of caution, which means patients are less sick and more likely to survive compared to those who do not having HIV.This larger number of patients would make HIV infection seem less of a problem than it is, said Dr. Matthew Spinelli, an infectious disease doctor at San Francisco General Hospital.

“Early studies may have misled people on this issue,” he said. The results of the new study are more in line with large, population-based studies from South Africa and England showing HIV infection doubles the risk of dying from Covid-19, and from a similar study in New York state, he added added.

The new findings should prompt doctors to give people with HIV quick access to monoclonal antibodies or antiviral drugs to treat Covid-19, said Dr. Deeks. The data also underscores the need to understand how HIV infection affects a person’s response to a Covid vaccine and whether some people with HIV need a booster vaccination, as many immunocompromised people do.

AIDS activists successfully campaigned for the inclusion of people with HIV in clinical trials with coronavirus vaccines, but the data are limited. A clinical study in South Africa showed the coronavirus vaccine, manufactured by Novavax, to be more effective than analysis excluded people with HIV, suggesting that HIV infection undermines the immune response to vaccines.

Out of 100 countries that have released information, 40 listed people with HIV as a priority group for Covid-19 vaccination, said Dr. Meg Doherty, WHO directs HIV programs