HIV status alters disease severity and immune cell responses inβvariant SARS-CoV-2 infection wave

  1. Farina Karim
  2. Inbal Gazy
  3. Sandile Cele
  4. Yenzekile Zungu
  5. Robert Krause
  6. Mallory Bernstein
  7. Yashica Ganga
  8. Hylton Rodel
  9. Ntombifuthi Mthabela
  10. Matilda Mazibuko
  11. Khadija Khan
  12. Daniel Muema
  13. Dirhona Ramjit
  14. Thumbi Ndung’u
  15. Willem Hanekom
  16. Bernadett I. Gosnell
  17. COMMIT-KZN Team
  18. Richard Lessells
  19. Emily Wong
  20. Tulio de Oliveira
  21. Mahomed-Yunus S. Moosa
  22. Gila Lustig
  23. Alasdair Leslie
  24. Henrik Kløverpris
  25. Alex Sigal
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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 (βdominated) 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.

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