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.

References:

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