10 July 2021
Illustration: Lisa Nelson
A South African patient with uncontrolled HIV could not clear the virus that causes Covid-19 from her body for 216 days, researchers have found. Over that time the virus, SARS-CoV-2, mutated a lot.
This case was presented by Dr Alex Sigal, from the Africa Health Research Institute in KwaZulu-Natal, and the Max Planck Institute for Infection Biology in Berlin, at this year’s European Congress of Clinical Microbiology & Infectious Diseases, which was held online on Friday. The research has also been published as a preprint (in other words it’s not yet peer-reviewed).
HIV is one of the comorbidities associated with greater risk of hospitalisation and death with Covid-19, but it is a much lower risk for hospitalisation and death than, for example, diabetes.
The authors raised the concern that patients like this one, with HIV that was untreated or not responding to treatment, may struggle to rid their bodies of SARS-CoV-2. In other words they may remain infectious for a long time with mutated versions of the virus. Better control of HIV with antiretroviral therapy could be the key to preventing this from happening.
“Evolved mutations lead to escape from neutralisation, which means antibodies made as a result of previous natural infection or vaccination would work less well to protect you from a new infection. SARS-CoV-2 may mutate extensively within one person if infection persists,” Sigal said.
While most people clear a SARS-CoV-2 infection within a few weeks, there are now several reports of long-term infections in people who have poor immune systems, according to the study. Only one of these was recorded in a patient living with HIV; the rest were people with certain types of cancer or taking therapies to suppress their immune systems (such as recipients of organ transplants).
In this particular case study, a woman in her late 30s was hospitalised for nine days. During this time she was enrolled in a study that looked at the effect of HIV infection on the immune response to SARS-CoV-2 infection. She was tested for Covid-19 nine times over 233 days. Up until day 216 her tests were all positive.
Her SARS-CoV-2 viruses were genetically analysed. Many mutations were found, including on the important spike protein which the virus uses to enter human cells. If these mutate it becomes difficult for the body’s antibodies to detect the virus and makes one more vulnerable to infection.
“Such findings underline the need to make sure everyone living with HIV has appropriate treatment. If not, it is possible that potentially more potent variants than the ones circulating now could emerge from people whose immune systems are severely damaged,” Sigal explained.
On day 190, her antiretroviral therapy was changed. Finally, her body was able to suppress HIV and only after this did she manage to test negative for Covid-19.
Control of HIV with antiretrovirals may be key to preventing the evolution of SARS-CoV-2 in people with advanced HIV, said Sigal.
If people with HIV are more likely to have long-term Covid infections like this, then it justifies prioritising them for Covid vaccination, the study concludes.