HIV alters SARS-CoV-2 immune response without affecting COVID-19 symptoms or outcomes

Studies have shown that severe coronavirus disease 2019 (COVID-19) correlates with lymphopenia and low T cell concentrations, and mild COVID-19 correlates with a strong T cell response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. While most individuals infected with SARS-CoV-2 produce neutralizing antibodies, the effectiveness of this antibody response may be partly compromised by the loss of CD4 T follicular helper cells and increased extrafollicular B cell expansion seen in severe COVID-19.

The immune response to SARS-CoV-2 also includes innate immune cytokine release, including IL6, IL8, and 26 CXCL10/IP10. IP-10 shows strong correlation with severe clinical outcomes and CXCR3 has been shown to be involved in the trafficking of antiviral T cells to tissue compartments.

How does HIV infection affect COVID-19 disease?

Not much is known about how HIV modulates the immune response to COVID-19. HIV can cause dysregulation of T cell responses, which in turn can cause B cell dysregulation and dysfunction. Thus, HIV co-infection will likely change the COVID-19 immune response.

Epidemiological studies have obtained mixed results on the interaction of HIV and SARS-CoV-2. Many extensive studies have observed that HIV co-infection can increase mortality risk in COVID-19 by approximately 1.5 to 3-fold, while most of these studies found no statistically significant changes in clinical presentation.

: Study characteristics. (A) Study timeline. (B) Time from symptom onset or diagnostic swab to study enrollment for symptomatic participants. Left panel shows time elapsed for HIV negative (blue points) and PLWH (red points) between symptom onset and enrollment. Middle panel shows days from the time the diagnostic swab was taken to enrollment for HIV negative and PLWH. Right panel shows time difference between symptom onset and diagnostic swab. (C) Percentage of participants attending follow-up visits for all participants (green), HIV negative (blue), and PLWH (red). (D) Number of visits (from a total of 5 study time-points per participant) for each participants. Median and IQR for all participants (green), HIV negative (blue), and PLWH (red).
Study characteristics. (A) Study timeline. (B) Time from symptom onset or diagnostic swab to study enrollment for symptomatic participants. Left panel shows time elapsed for HIV negative (blue points) and PLWH (red points) between symptom onset and enrollment. Middle panel shows days from the time the diagnostic swab was taken to enrollment for HIV negative and PLWH. Right panel shows time difference between symptom onset and diagnostic swab. (C) Percentage of participants attending follow-up visits for all participants (green), HIV negative (blue), and PLWH (red). (D) Number of visits (from a total of 5 study time-points per participant) for each participants. Median and IQR for all participants (green), HIV negative (blue), and PLWH (red).

Impact of HIV on COVID-19 immune response in an African region with high HIV prevalence

In a preprint paper published on the medRxiv* server, a team of researchers from various institutions in South Africa, the UK, and Europe discuss how they determined the impact of HIV on the COVID-19 immune response in KwaZulu-Natal, South Africa, which is an area with very high HIV prevalence. The researchers believe that this study will help understand the long-term consequences of COVID-19 infection and the vaccination response in this population.

The team investigated used four longitudinal samples from 124 study participants from KwaZulu-Natal, South Africa. 44% of the participants were people living with HIV and had other co-morbidities such as hypertension, obesity, and diabetes.

COVID-19 immune response differed significantly between people living with HIV and HIV negative participants

Most people living with HIV showed CD8 T cell expansion above the normal range after a SARS-CoV-2 infection. In participants who underwent antiretroviral therapy to suppress HIV, CD8 expansion was associated with milder COVID-19 disease.

There were many differences in T cell, B cell, and natural killer cell correlations in people living with HIV and participants who were HIV negative. Lower tissue homing CXCR3+ CD8 T cells in the presence of SARS-CoV-2 RNA was seen in people living with HIV, but not in HIV negative participants. There was a pronounced early antibody-secreting cell expansion in HIV-negative individuals, while this was absent in people living with HIV.

Low CXCR3 correlated with increased COVID-19 severity across groups, while high antibody-secreting cells correlated with increased disease severity in HIV negative individuals and waned once SARS-CoV-2 was cleared.

HIV infection status did not affect the severity of COVID-19 disease

Overall, the results show that despite the altered immune response, COVID-19 disease was mostly mild in people living with HIV, similar to participants who were HIV negative. This is likely a reflection of the heterogeneity of an effective COVID-19 immune response. It is yet to be determined if the differences in immune responses in people living with HIV will compromise vaccination or lead to different long-term consequences.

“We have shown that HIV infection changed the immune cell response but not clinical outcomes or symptoms of COVID-19 infection.”

The researchers also observed that HIV viremia affects the COVID-19 immune response in people living with HIV, including consistently elevated CD8 T cell levels whether or not SARS-CoV-2 RNA is present and the lack of CD4 T cell recovery after SARS-CoV-2 clearance. Hence, effective ART suppression likely has a role in attenuating the effects of HIV infection on the immune response to COVID-19.

“Given that COVID-19 infection outcomes were similar in PLWH relative to HIV negative participants, the differences in immune response between the groups may indicate an alternative, as opposed to dysregulated, immunity to SARS-CoV-2 in PLWH.”

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
  • HIV infection alters SARS-CoV-2 responsive immune parameters but not clinical outcomes in COVID-19 disease, Farina Karim, Inbal Gazy, Sandile Cele, Yenzekile Zungu, Robert Krause, Mallory Bernstein, Yashica Ganga, Hylton Rodel, Ntombifuthi Mthabela, Matilda Mazibuko, Khadija Khan, Daniel Muema, Dirhona Ramjit, Gila Lustig, Thumbi Ndung’u, Willem Hanekom, Bernadett I. Gosnell, COMMIT-KZN Team, Emily Wong, Tulio de Oliveira, Mahomed-Yunus S. Moosa, Alasdair Leslie, Henrik Kløverpris, Alex Sigal, medRxiv 2020.11.23.20236828; doi: https://doi.org/10.1101/2020.11.23.20236828, https://www.medrxiv.org/content/10.1101/2020.11.23.20236828v1
Susha Cheriyedath

Written by

Susha Cheriyedath

Susha has a Bachelor of Science (B.Sc.) degree in Chemistry and Master of Science (M.Sc) degree in Biochemistry from the University of Calicut, India. She always had a keen interest in medical and health science. As part of her masters degree, she specialized in Biochemistry, with an emphasis on Microbiology, Physiology, Biotechnology, and Nutrition. In her spare time, she loves to cook up a storm in the kitchen with her super-messy baking experiments.

Citations

Please use one of the following formats to cite this article in your essay, paper or report:

  • APA

    Cheriyedath, Susha. (2020, November 26). HIV alters SARS-CoV-2 immune response without affecting COVID-19 symptoms or outcomes. News-Medical. Retrieved on January 23, 2021 from https://www.news-medical.net/news/20201126/HIV-alters-SARS-CoV-2-immune-response-without-affecting-COVID-19-symptoms-or-outcomes.aspx.

  • MLA

    Cheriyedath, Susha. "HIV alters SARS-CoV-2 immune response without affecting COVID-19 symptoms or outcomes". News-Medical. 23 January 2021. <https://www.news-medical.net/news/20201126/HIV-alters-SARS-CoV-2-immune-response-without-affecting-COVID-19-symptoms-or-outcomes.aspx>.

  • Chicago

    Cheriyedath, Susha. "HIV alters SARS-CoV-2 immune response without affecting COVID-19 symptoms or outcomes". News-Medical. https://www.news-medical.net/news/20201126/HIV-alters-SARS-CoV-2-immune-response-without-affecting-COVID-19-symptoms-or-outcomes.aspx. (accessed January 23, 2021).

  • Harvard

    Cheriyedath, Susha. 2020. HIV alters SARS-CoV-2 immune response without affecting COVID-19 symptoms or outcomes. News-Medical, viewed 23 January 2021, https://www.news-medical.net/news/20201126/HIV-alters-SARS-CoV-2-immune-response-without-affecting-COVID-19-symptoms-or-outcomes.aspx.

Comments

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
You might also like... ×
Could Vitamin D be an effective adjuvant to help mitigate the COVID-19 pandemic?