Recently, a buddy of mine in Houston who works in HIV-treatment was telling me that he’s seeing few COVID-19 infections among his HIV-positive patients and among those of his patients taking PrEP [HIV-prevention] drugs. Anecdotal evidence, of course. But we wondered if someone were doing a scientific study to see if these antiretrovirals were conferring some measure of COVID-19 protection . . . and it turns out someone was:
www.hivplusmag.com/...
A study of tens of thousands of HIV-positive Spaniards found they faced less risk of dying or getting seriously ill from COVID-19 than people without HIV.
Researchers specifically cited the use of antiretroviral therapy — specifically medications that include a nucleotide reverse transcriptase inhibitor (NRTI) backbone of tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) — as a factor in the lower risks, according to the study published in the Annals of Internal Medicine and reported in the American Journal of Managed Care.
The American Journal of Managed Care article is a little more detailed:
Compared with the general population, this risk for COVID-19 diagnosis was lower among persons with HIV: 30.0 vs 41.7 per 10,000 persons.
And the reason?
The authors [of the study] proposed that the low risk of death and hospitalization for HIV-positive patients on NRTI regimens comes from “molecular docking and extension reactions with RNA-dependent RNA polymerase (RNAdRNAp).” Essentially, NRTIs may be effective at fighting COVID-19 because they inhibit RNAdRNAp. In particular, the small size of tenofovir diphosphate, which is the common active triphosphate form of TAF or TDF, has been cited because it “fits better in the active site of SARS-CoV-2 RNAdRNAp.”
So, if I’m understanding right (big if), the antiretrovirals inhibit the site where COVID-19 “docks” on cells. Groovy.
Of course, this is only one study. But it’s interesting and perhaps could lead to COVID-19 prevention drugs. And there’s something ironic—good ironic—that those whose lives have been touched by one pandemic may have a little help dealing with this new one.