HIV status alters disease severity and immune cell responses in beta variant SARS-CoV-2 infection wave
- Africa Health Research Institute, South Africa
- Tel Aviv University, Israel
- Africa Health Research Institute; School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, South Africa
- Africa Health Research Institute; Division of Infection and Immunity, University College London, South Africa
- Department of Infectious Diseases, Nelson R. Mandela School of Clinical Medicine, University of KwaZulu-Natal, South Africa
- University of KwaZulu-Natal, South Africa
- KwaZulu-Natal Research Institute for TB-HIV, South Africa
- University of KwaZulu-Natal,SA, South Africa
- Centre for the AIDS Programme of Research in South Africa, South Africa
- African Health Research Institute, South Africa
- Africa Health Research Institute, University of KwaZulu-Natal, South Africa
Abstract
There are conflicting reports on the effects of HIV on COVID-19. Here we analyzed disease severity and immune cell changes during and after SARS-CoV-2 infection in 236 participants from South Africa, of which 39% were people living with HIV (PLWH), during the first and second (beta dominated) infection waves. The second wave had more PLWH requiring supplemental oxygen relative to HIV negative participants. Higher disease severity was associated with low CD4 T cell counts and higher neutrophil to lymphocyte ratios (NLR). Yet, CD4 counts recovered and NLR stabilized after SARS-CoV-2 clearance in wave 2 infected PLWH, arguing for an interaction between SARS-CoV-2 and HIV infection leading to low CD4 and high NLR. The first infection wave, where severity in HIV negative and PLWH was similar, still showed some HIV modulation of SARS-CoV-2 immune responses. Therefore, HIV infection can synergize with the SARS-CoV-2 variant to change COVID-19 outcomes.
Data availability
All data generated or analysed during this study are included in the manuscript and supporting files
Article and author information
Author details
Richard J Lessells
Funding
Bill and Melinda Gates Foundation (INV-018944)
- Alex Sigal
The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.
Ethics
Human subjects: The study protocol was approved by the University of KwaZulu-Natal Institutional Review Board (approval BREC/00001275/2020). Adult patients ($>$18 years old) presenting either at King Edward VIII or Clairwood Hospitals in Durban, South Africa, between 8 June to 25 September 2020, diagnosed to be SARS-CoV-2 positive as part of their clinical workup and able to provide informed consent were eligible for the study. Written informed consent was obtained for all enrolled participants.
Reviewing Editor
- Lishomwa Ndhlovu
Version history
- Received: February 9, 2021
- Accepted: September 7, 2021
- Accepted Manuscript published: October 5, 2021 (version 1)
- Accepted Manuscript updated: October 6, 2021 (version 2)
- Version of Record published: December 16, 2021 (version 3)
Copyright
© 2021, Karim et al.
This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.
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HIV status alters disease severity and immune cell responses in beta variant SARS-CoV-2 infection wave
eLife 10:e67397.
https://doi.org/10.7554/eLife.67397
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