COVID‐19 in people living with HIV: Clinical implications of dynamics of the immune response to SARS‐CoV‐2

Abstract

Background Little evidence on COVID‐19 in people living with HIV (PLWH) is currently available. Material and Methods We reported clinical and viro‐immunological data of all HIV‐positive patients admitted to our centre with COVID‐19 from March 1 to May 12 , 2020. Results Overall, five patients were included: all were virologically‐suppressed on antiretroviral therapy and CD4+ count was >350 cell/mm 3 in all but two patients. Although all patients had evidence of pneumonia on admission, only one developed respiratory failure. SARS‐CoV‐2‐RNA was never detected from nasopharyngeal swabs in two patients, whereas, in the others, viral clearance occurred within a maximum of 43 days. IgG production was elicited in all patients and neutralizing antibodies in all but one patient. Specific‐T‐cell response developed in all patients but was stronger in those with more severe presentation. Similarly, the highest level of pro‐inflammatory cytokines was found in the only patient experiencing respiratory failure. Despite a mild presentation, patients with more pronounced immunosuppression showed high degrees of both cytokines production and immune‐activation. Conclusions Our study did not find an increased risk and severity of COVID‐19 in PLWH. Adaptative cellular immune response to SARS‐CoV‐2 appeared to correlate to disease severity. The mild clinical picture showed in advanced HIV patients, despite a significant T‐cell activation and inflammatory profile, suggests a potential role of HIV‐driven immunological dysregulation in avoiding immune‐pathogenetic processes. However, other possible explanations, as a protective role of certain antiretroviral drugs, should be considered. Further larger studies are needed to better clarify the impact of HIV infection on COVID‐19. This article is protected by copyright. All rights reserved.

HIV/SARS-CoV-2 co-infection: T cell profile, cytokine dynamics and role of exhausted lymphocytes

“…The ability of HIV/SARS-CoV-2 co-infection to cause excessive T cell activation has been observed in sample sets little in size ( D’Ettorre et al, 2020 , Gao et al, 2020 ). Besides, it has been detected that COVID-19 severe symptomatic manifestations may lead to a more pronounced T cell response than mild symptomatic clinical course ( Ho et al, 2020 , Mondi et al, 2020 ).…”

People Living with HIV Easily Lose Their Immune Response to SARS-CoV-2: Result from a Cohort of COVID-19 Cases in Wuhan, China

“…In addition, ndings from other studies suggested that an impaired immune reactivity could contribute to low IgG positive [22]. Although this may suggest that PLWH may be more vulnerable with a SARS-CoV-2 infection, ndings from other studies have observed no increased risk and severity of COVID-19 in affected PLWH [23]. Regardless, the risk of increased PLWH vulnerability should not be ignored as the reported similarity in immune response may only apply to PLWH.…”

Profile of SARS-CoV-2-specific CD4 T cell response: Relationship with disease severity and impact of HIV-1 and activeMycobacterium tuberculosisco-infection

“…To date, the immunological impact of HIV on SARS-CoV-2 immune response has been mainly reported in isolated or limited cases of co-infection (d’Ettorre et al, 2020; Mondi et al, 2020; Wang et al, 2020). Only two studies have measured the effect of HIV-1 infection on the overall profile of T cells in COVID-19 cases: Karim et al .…”

“…To date, the immunological impact of HIV on SARS-CoV-2 immune response has been mainly reported in isolated or limited cases of co-infection (d' Ettorre et al, 2020;Mondi et al, 2020;Wang et al, 2020). Only two studies have measured the effect of HIV-1 infection on the overall profile of T cells in COVID-19 cases: Karim et al showed that viraemic HIV-infected COVID-19 patients exhibited lower frequencies of tissue homing CXCR3+ CD8 T cells and higher T cell activation compared to HIV-uninfected patients (Karim et al, 2020).…”