A Spanish study on HIV and COVID-19

Doctors at 60 HIV clinics in Spain pooled their data, collected between February and April 2020, to better understand the impact of the coronavirus on the health of people taking antiretroviral therapy (ART).

Out of 77,590 HIV-positive people in these clinics who were taking ART, 236 were diagnosed with COVID-19. Of these 236 people, 151 (64%) were hospitalized, 15 (6%) were admitted to an intensive care unit (ICU) and 20 (8%) died.


The researchers compared health-related information from HIV-positive and HIV-negative people with COVID-19 in Spain and drew the following conclusions:

Risk for a diagnosis of COVID-19

  • HIV-positive people – 30 cases per 10,000 people
  • HIV-negative people – 42 cases per 10,000 people

Risk of death with COVID-19

  • HIV-positive people – 4 cases per 10,000 people
  • HIV-negative people – 2 cases per 10,000 people

All cases of COVID-19 were diagnosed with PCR (polymerase chain reaction).

Focus on HIV

Among HIV-positive people, researchers found that those over the age of 70 and men were at greatest risk for COVID-19 diagnosis and hospitalization.

In general, the time spent in hospital increased with a person’s age. For instance, people aged 20 to 39 years spent about four days in the hospital, while people aged 70 to 79 years were hospitalized for about nine days.

HIV medicines

The drugs tenofovir DF (TDF) and FTC are combined in a pill and sold under the brand name Truvada and in generic formulations. A newer formulation of tenofovir, called TAF, is also combined in a pill with FTC and sold under the brand name Descovy.

The Spanish researchers found that the risk for certain outcomes was lower among people who took TDF + FTC. For instance, people taking those drugs had a 57% reduced risk of being diagnosed with COVID-19 and a 47% reduced risk of being hospitalized.

Bear in mind

The researchers urge caution when interpreting the finding that there appears to be a greater risk of death among HIV-positive people who were hospitalized with COVID-19. This trend needs to be explored with a much larger number of people and done over a longer period of time.

The findings concerning the potential impact of HIV treatment are interesting. However, the study’s conclusions are clouded by the possibility of being skewed by unmeasured factors. The number of HIV-positive people was relatively small and the study design was observational. We do not know why some people were prescribed TDF + FTC and others were not. It is plausible that people who were prescribed TDF + FTC were healthier than people who did not take these drugs. It would have been helpful to have more data about the health of the HIV-positive people who were diagnosed with COVID-19 and who required hospitalization. For instance, factors such as CD4+ cell counts, the lowest-ever (“nadir”) CD4+ cell count, the ratio of CD4 to CD8 cells, duration of viral suppression, and so on perhaps could have contributed more to an analysis of risk. Note that the first wave of the pandemic was particularly bad in Spain and researchers had to scramble to assemble data on what was happening in their HIV-positive population.

Other studies from France and Spain (reported later in this issue of TreatmentUpdate) have not found any conclusive link between the use of tenofovir-containing regimens and a reduced risk for infection with SARS-CoV-2 or other outcomes.

A large randomized clinical trial is underway in Spain to assess the impact of TDF + FTC in preventing infection with SARS-CoV-2.

—Sean R. Hosein


  1. Del Amo J, Polo R, Moreno S, et al. The Spanish HIV/COVID-19 Collaboration. Incidence and severity of COVID-19 in HIV-positive persons receiving antiretroviral therapy: a cohort study. Annals of Internal Medicine. 2020 Oct 6;173(7):536-541.
  2. Charre C, Icard V, Pradat P, et al. Coronavirus disease 2019 attack rate in HIV-infected patients and in preexposure prophylaxis users. AIDS. 2020 Oct 1;34(12):1765-1770.
  3. Ayerdi O, Puerta T, Clavo P, et al. Preventive efficacy of tenofovir/emtricitabine against SARS-CoV-2 among PrEP users. Open Forum Infectious Diseases. 2020; in press.