Unsuppressed HIV Less Likely to Maintain Effective COVID-19 Neutralization

Unsuppressed HIV viral loads were associated with lower rates of COVID-19 Beta variant neutralization.

COVID-19 Beta variant neutralization was found to be less likely among patients with unsuppressed HIV infection, suggesting that HIV suppression is important for maintaining a potent neutralization response. These study findings were published in The Journal of Infectious Diseases.

Researchers assessed clinical outcomes among patients with HIV infection who were hospitalized with COVID-19 infection in South Africa during the wave dominated by the Beta (B.1.351) variant (December 2020-April 2021). None of the patients were vaccinated at the time of COVID-19 onset.

A total of 34 patients were included in the analysis, of whom 18 were positive and 16 were negative (controls) for HIV infection. Of the HIV-positive patients, 7 (21%) were virologically suppressed and 11 (32%) had unsuppressed viral loads (median CD4 count, 161 vs 713 cells/μL, respectively; P =.035), and 7 had a history of tuberculosis infection (P =.008). Of note, all virologically-suppressed patients with HIV infection were receiving antiretroviral therapy.

[T]he level of HIV suppression, not HIV status alone, may modulate the neutralizing immune response to SARS-CoV-2 variants.

The researchers evaluated patients for weekly changes in SARS-CoV-2 spike receptor-binding domain (RBD) antibodies up until 1 month following enrollment. They found that antibody concentrations among HIV-positive patients with unsuppressed viral loads were decreased compared with both those who were virologically suppressed and those without HIV infection. Further comparisons against HIV-negative and virologically-suppressed patients showed that Beta variant neutralization was 4.9-times lower among HIV-positive patients with unsuppressed viral loads.

A CD4 count below 500 cells/μL was found to be significantly associated with decreased rates of both immunoglobulin (Ig)G (P =.040) and IgA (P =.025) seroconversion was found to be decreased among patients with CD4 counts below 500 cells/μL. Compared with virologically unsuppressed patients, maximum IgG antibody concentrations observed during the study period were significantly increased among HIV-negative patients (P =.03).

This study was limited by its small sample size.

According to the researchers, “the level of HIV suppression, not HIV status alone, may modulate the neutralizing immune response to SARS-CoV-2 variants.”

Disclosure: This study was supported by the Bill and Melinda Foundation.


Hwa SH, Snyman J, Bernstein M, et al. Association between human immunodeficiency virus viremia and compromised neutralization of severe acute respiratory syndrome coronavirus 2 beta variant. J Infect Dis. Published online August 17, 2022. doi:10.1093/infdis/jiac343/6670446