In January, two weeks after Rick Solomon joined the YMCA near his home, he fell ill. The 65-year-old Berkeley resident hoped to spend the month working out, instead he laid in bed wheezing, with crippling muscle aches. He missed several days of work at a small publishing house.
“I was sick for most of the month of February with a horrible cough like I’ve never had before,” said Solomon running his fingers through his thick salt and pepper hair. “It went into my chest. I used inhalers for the first time in my life.”
He was never tested for COVID-19 because he hadn’t traveled overseas recently, which was one of the official requirements for testing at the time. And although he has since tested negative for the virus’ antibodies, Solomon still believes he may have caught the bug.
“The test the lab used was not FDA approved,” he said. “So who knows? It was just a different kind of cold.”
Solomon took the antibody test because he wanted to enroll in a study at Zuckerberg San Francisco General Hospital looking at HIV-positive people infected with COVID-19. It’s a topic of special interest to researchers.
“COVID is going to have a major impact on the trajectory of the HIV epidemic,” said Dr. Steven Deeks, a UCSF professor of medicine and HIV researcher. “We just don’t know how.”

Some answers may come to light this week at the 23rd International AIDS Conference. The event was scheduled to happen in San Francisco and Oakland until the coronavirus hit. Now scientists, policymakers, public health experts and patients from around the world will gather virtually. COVID-19 is a central topic on the agenda.
Surprising Positive Trend
Infectious disease doctors assumed people with HIV would be at higher risk for complications from the novel coronavirus due to a weakened immune system. Plus, the majority of HIV-positive people in the U.S. are older, and many struggle with underlying conditions like heart disease and diabetes, which make illness from COVID-19 infection more severe.
Early in the outbreak, four of Dr. Edward “Lalo” Cachay’s patients were hospitalized for complications with COVID-19. Cachay, a professor of medicine at UC San Diego, feared the worst.
“You could potentially have a very dangerous combination of both biological and social determinants of health,” said Cachay.
HIV patients are not only immunocompromised, many also face psycho-social barriers like poor health insurance and mental illness. But not only did Cachay’s four patients experience good outcomes, this positive trend is playing out across the globe.

“People with HIV are radically underrepresented in the different cohorts coming from Europe and China with very advanced, severe forms of COVID-19,” Cachay said.
Two small studies from Spain and Italy show that HIV-positive people infected with COVID-19 did not fare worse than those without HIV. Scientists are not sure why.
More Questions Than Answers
“The bottom line is we have no idea,” said Deeks. “We have lots of interesting questions, lots of important questions, and lots of anecdotes. But at the end of day, we don’t have much data at all.”
Cachay hopes a study he is involved in will offer concrete answers. He’s partnering with scientists at the Fred Hutchinson Cancer Research Center and the University of Washington to answer some key questions: What factors might predict which HIV patients are most at risk? Do HIV patients who contract COVID-19 suffer severe illness? And are mortality rates higher in HIV patients who contract the novel coronavirus?
“I hope this study will help us disentangle the data more,” said Cachay.
Some experts theorize daily HIV meds might offer some protection against the coronavirus. Others wonder if the immune system of people with HIV is altered in a way that offers some resilience. Or, perhaps, experience helps.
“I am pretty sure that my patients, my older, primarily gay men who survived the ’80s and ’90s, were the first to effectively shelter in place because they know what a pandemic is,” said Deeks. “They know how a virus can ravage a community. They know how important social distancing is.”



