The novel coronavirus SARS-CoV-2 keeps the world on tenterhooks: There are approved treatment options, worldwide research on vaccines is feverish – at the same time health authorities and hospitals try to get the second wave under control. HIV, on the other hand, has evolved in recent years from a global threat to a manageable chronic disease – at least in countries with highly developed healthcare systems. Both pathogens – HIV and SARS-CoV-2 – originated in animals as zoonoses and still require immense efforts to bring them under control, respectively. to hold. The most important clinical aspects of both viral diseases will be discussed in our online symposium on 2. December from 6 to 8 p.m. illuminated. The online symposium is organized by the interdisciplinary HIV Center IZAR at the Klinikum rechts der Isar under the leadership of infectiologist and senior physician PD Dr. Christoph Spinner.
Associate Professor Dr. Christoph Spinner is an infectiologist and heads the HIV Center IZAR at Klinikum rechts der Isar (© argum, Klinikum rechts der Isar and stock vector number: 1660181482, Fotomay)
"Early on during the first wave of corona, we saw that we can’t keep all the resources for Covid-19," says Dr. Christoph Spinner. "There were startling figures from the World Health Organization on the sidelines of the World AIDS Conference in July 2020: Globally, not only has the supply of HIV antiretroviral therapy collapsed, but z.B. including the provision of vaccination campaigns, prenatal care, etc."In Germany, during the first wave of corona, there was suddenly a significant decrease in strokes and heart attacks, including at Klinikum rechts der Isar. People have stopped going to the hospital even for serious and potentially life-threatening illnesses for fear of contracting SARS-CoV-2.
The similarities between HIV and SARS-CoV-2
HIV and SARS-CoV-2 are transmitted differently, but they are both viruses that have spread relatively quickly worldwide and were previously unknown. Both viruses have moved from the animal kingdom to humans as zoonotic diseases. Both pathogens have caused fear in the population and led to a stigmatization of the affected patients.
HIV-positive people – people at risk for covid-19?
"Patients* who receive good antiretroviral therapy are usually not at increased risk for severe Covid-19," says Dr. Christoph Spinner. The situation is different for HIV patients* with reduced helper cells, which are important for the immune response. You belong to the risk group. People at higher risk for Covid-19 in general are those with obesity, pulmonary or cardiovascular disease, hypertension and diabetes, and patients* aged 60 and older. "It is of course theoretically true that we need to give special protection to at-risk groups," says Dr. Christoph Spinner. But in practice, there is a lack of feasible concepts for this. People infected with coronavirus are contagious even before symptoms begin. This makes prevention in nursing and medical facilities very difficult, he says.
Vaccine: HIV vs. SARS-CoV-2
Even after 40 years, there is still no vaccination against HIV, but there are effective therapies that enable a normal life and prevent virus transmission. Fortunately, effective pre-exposure prophylaxis (PrEP) is now available, reducing the likelihood of HIV infection by 86-99 percent. For other diseases not every vaccine achieves such a good protection. It is not yet known how effective a vaccine against SARS-CoV-2 will be. "Current vaccine candidates have shown that they can activate the immune system and induce antibody production," says Dr. Christoph Spinner. "Immunity is possible. This can also be seen in the fact that a second infection cannot occur immediately after a covid-19 disease has been overcome, apart from individual cases."But the development of a new vaccine typically takes about 15 years, he said, and only about six out of every hundred candidates are finished being developed. "We know from other respiratory viruses such as influenza that sustained immunity is difficult to achieve, so repeated vaccination is needed."
What we can learn from HIV for Covid-19
People initially reacted to both viruses with fear. "It is in the nature of humans to stay away from sick people to protect themselves," said Dr. Christoph Spinner. "In part, however, people with Covid-19 have experienced, like AIDS patients, that much of the social environment has turned away from them."In the process, Covid-19 heals and brings some immunity afterward. "In both cases – AIDS and Covid-19 – there were efforts to isolate at-risk groups because of fear of transmission."In all pandemics – including previous influenza pandemics – the concept of herd immunity exacted a very high price in terms of a high death toll.
Research on HIV and SARS-CoV-2
A great deal of research capacity is currently being diverted to Covid-19. This is true for pharmaceutical companies and organizations that have previously conducted research on HIV, as well as hospitals, university hospitals and universities. This not only affects HIV research, but also research into countless other serious diseases in general. "I believe that more effective drugs will be approved for Covid-19, just as they were for HIV. There will probably also be agents for prophylaxis of Covid-19 that can be used before or after contact with SARS-CoV-2, i.e., pre- and post-exposure prophylaxis," says Dr. Christoph Spinner. When it comes to vaccination, however, one must remain realistic: "Corona will certainly keep us busy beyond 2021, even if there are vaccines available. We will not get close to a normal life like before Covid-19 until a large part of the population has acquired immunity to SARS-CoV-2 – ideally through safe and effective vaccination rather than infection!"