Let $\Sigma$ be an integral homology sphere (from now on I will drop the word 'integral').
If $\Sigma$ is simply connected, then it is homotopy equivalent to a sphere by Whitehead's Theorem, and hence homeomorphic to a sphere by the solution of the topological Poincaré conjecture.
If $\pi_1(\Sigma)$ is infinite, then $\widetilde{\Sigma}$ is non-compact; in particular, it is not a homology sphere.
Suppose now that $\pi_1(\Sigma)$ is finite but non-trivial. If $\dim\Sigma$ is even, then $\chi(\widetilde{\Sigma}) = |\pi_1(\Sigma)|\chi(\Sigma) = 2|\pi_1(\Sigma)|$, so $\widetilde{\Sigma}$ is not a homology sphere. If $\dim\Sigma$ is odd, then there are examples where $\widetilde{\Sigma}$ is a homology sphere, e.g. the Poincaré homology sphere which has $S^3$ as its universal cover.
If $\Sigma$ is an odd-dimensional homology sphere and $\pi_1(\Sigma)$ is finite, is $\widetilde{\Sigma}$ necessarily a homology sphere?
If the answer were yes, then $\widetilde{\Sigma}$ would be a simply connected homology sphere and hence $\widetilde{\Sigma}$ is a sphere by the argument above. In dimension three, the only homology sphere with finite fundamental group is the Poincaré homology sphere, so if there is a counterexample (which I suspect there is), it must have dimension at least five.