HIV pandemic vs. COVID-19: How do the pandemics compare?

HIV attacks a person’s immune system, rendering their bodies unable to fight off illnesses. Left untreated, a person with HIV can develop AIDS. This refers to the final phase of HIV infection, where damage to the immune system is so severe that it results in an increasing number of opportunistic infections.

Coronavirus disease 2019 (COVID-19) is an infection caused by a novel strain of coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). People with COVID-19 can develop mild to very severe respiratory illness and a number of other possible symptoms.

HIV is a Lentivirus, which is a genus of retroviruses. These types of viruses are known to have long incubation periods that can cause chronic and deadly diseases. HIV has two types, HIV-1 and HIV-2. Learn more about their differences here.

HIV attacks the immune system by infecting immune cells called CD4 cells. After infecting these immune cells, HIV uses it to produce copies of itself then kills the CD4 cells, which weakens the immune system. HIV spreads through the exchange of various bodily fluids, such as blood, semen, and vaginal fluids.

SARS-CoV-2 is a virus that comes from a large family of viruses called coronavirus that have characteristic crown-like projections on their surfaces. Other notable coronaviruses include severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV).

Some types of coronavirus cause the common cold. But these are different from the SARS-CoV-2 virus that causes COVID-19.

While illness due to SARS-CoV-2 may often be mild to moderate, in some cases people can become seriously ill. COVID-19 can affect organ systems across the entire body, including the lungs, heart, brain, kidneys and more. In some cases, even a mild or asymptomatic COVID-19 infection can result in symptoms lasting more than 4 weeks, a condition known as post-acute COVID-19 syndrome (PACS) or long COVID.

SARS-CoV-2 is primarily an airborne infection, meaning the virus may be transmitted through respiratory droplets and tiny floating particles that a person releases when breathing, coughing, sneezing, or talking. It can also spread by touching contaminated surfaces.

During the early days of both pandemics, aside from shock, most of the world’s governments responded with denial, downplaying, delayed responses, and neglect. Both pandemics have instilled great fear in the population, caused disruption of everyday life, and led to the deaths of many people.

Another similarity is the necessity of public participation in reducing transmission.

With COVID-19, limiting spread of the SARS-CoV-2 virus largely depends on people following guidance and protocols. These include staying up-to-date with vaccines and boosters, improving ventilation, using a mask, testing when a person has symptoms, and staying home when sick.

Similarly, testing and other protocols exist to reduce HIV transmission. People with HIV, or those who suspect exposure to the virus, test for an infection and receive treatment to lower their viral load to reduce symptoms and the risk of transmission.

Behaviors such as condom use and using new, unshared syringes can also reduce transmission.

Additionally, both viruses are examples of zoonosis, as they have animal origins and are now capable of infecting humans. Furthermore, most research also suggests that both viruses became transmissible to humans following the consumption of animals with the original infection.

COVID-19 remains a major global health issue. Similarly, despite the world adopting the World Health Organization’s (WHO) strategic guidelines to control the disease, the HIV pandemic is ongoing.

A significant difference between the two pandemics is their timelines. While positive cases and deaths from HIV and AIDS continue worldwide, the spread of HIV since its discovery in the 1980s is slow compared with COVID-19’s millions of cases and deaths since its recognition in late 2019.

Also, while there are already several successful vaccines that help protect against severe outcomes with COVID-19, there is still no success in creating a vaccine for HIV or AIDS. However, medications are available that can treat HIV effectively and prevent people from transmitting or contracting it.

Both viruses can spread from people who unknowingly have the infection but present with no symptoms. However, while HIV is most contagious during its acute phase, it remains contagious in people not receiving any treatment.

In comparison, the Centers for Disease Control and Prevention (CDC) state that with COVID-19, a person should isolate at home for at least the first 6 days.

If a person is fever-free for 24 hours without fever-reducing medications and their other symptoms are improving, they can leave isolation after 6 days. After ending isolation, should continue to wear a high-quality mask indoors until 11 days after symptoms began.

However, some people may need to isolate for longer based on factors such as the severity of the COVID-19 infection and whether a person is immunocompromised.

One stark difference between the two viruses is that SARS-CoV-2 is very easily transmittable due to it being an airborne infection, whereas HIV transmission relies on contact with bodily fluids that contain the virus.

Furthermore, people may develop symptoms of COVID-19 2–14 days after exposure to the virus, while it typically takes 2–4 weeks after infection for people to present with primary symptoms of HIV.

Based on the WHO’s coronavirus (COVID-19) dashboard, there have been over 750 million confirmed COVID-19 cases, including nearly 7 million deaths due to the disease.

Meanwhile, since the beginning of the HIV pandemic, there has been almost 85 million cases of HIV infection. Of these, nearly 40 million people have died from AIDS-related illnesses.

A 2021 review mentions that more than 95% of people with HIV who do not receive treatment die, while 1–4% of people with COVID-19 who do not receive treatment die.

There are currently no effective cures for the illnesses caused by either virus. However, treatments to reduce symptom severity and strategies to prevent or reduce the risk of transmission exist.

In some cases, people may be able to manage and relieve mild symptoms of COVID-19 at home.

The Food and Drug Administration (FDA) has issued Emergency Use Authorization (EUA) for two prescription medications for people at risk of serious illness from COVID-19: nirmatrelvir with ritonavir (Paxlovid) and molnupiravir. Both of these medications can be taken at home in pill form.

For more severe cases that require hospitalization, the FDA has approved remdesivir (Vekclury) and has issued EUAs for several other treatments, including monoclonal antibodies.

The CDC recommends the following to protect individuals and others from getting COVID-19:

• stay up-to-date with vaccines and boosters
• improve airflow and ventilation
• test for COVID-19 when a person has symptoms
• if a person develops symptoms, follow protocols including isolating at home and wearing a mask indoors after ending isolation
• if a person may have been exposed to the virus, follow protocols including wearing a mask indoors and monitoring for symptoms
• stay home when sick
• follow additional measures based on community levels and personal risk

Many safe and effective vaccines for COVID-19 are available. These vaccines can prevent a person from becoming seriously ill if they develop COVID-19 and may reduce the transmission of SARS-CoV-2.

With access to effective treatment, HIV is a manageable condition to live with and people with HIV live full, healthy lives. Individuals with HIV receive antiretroviral therapies (ART), which are treatment regimens consisting of two or more drugs that suppress the virus from replicating.

This can help a person to reduce their viral load to such an extent that it is undetectable. This means that a person can no longer transmit the virus to another person, and it also prevents the condition from progressing.

Preventive measures are still in place to prevent the spread of both viruses. The CDC recommends preventive strategies for HIV that include:

• modifying sexual practices, including condom use
• use of pre-exposure prophylaxis (PrEP)
• use of post-exposure prophylaxis (PEP)
• no needle sharing
• testing for and treating HIV

COVID-19 vaccine rollouts are continuing across the globe. Based on Our World in Data, roughly 70% of the world population have received at least one dose of a COVID-19 vaccine.

However, there is still a disparity between wealthy and low income countries when it comes to COVID-19 vaccination efforts. Currently, only about 30% of people in low income countries have received at least one dose of a COVID-19 vaccine.

Currently, there are four vaccines available in the United States, and more have received approval for full use globally. Scientists are continuing their research on developing new and more effective vaccines.

Meanwhile, due to the nature of HIV, it is more difficult to develop an effective vaccine. However, research is ongoing. Currently, research efforts include a late-stage, multinational vaccine clinical trial called Mosaico.

Additionally, researchers are working on developing broadly neutralizing antibodies (bNabs), which may be able to stop a wide range of HIV strains. A 2020 study suggests the potential of using adeno-associated viruses and monkeys to produce monoclonal antibodies that may offer lifelong protection against HIV.

COVID-19 and HIV are diseases caused by two contagious viruses that are responsible for global pandemics. The viruses share certain similarities like their origin, but they also have stark differences in their symptoms, mode of transmission, and disease course.

Due to these differences, public health measures vary in the preventive measures they employ. At present, there are no vaccines against HIV, but treatment options exist that can help prevent transmission. As for COVID-19, safe and effective vaccines are available that can reduce symptom severity and help reduce transmission.