SARS-CoV-2 prolonged infection during advanced HIV disease evolves extensive immune escape

Milder disease with Omicron: is it the virus or the pre-existing immunity?

“…The emergence of another major variant of concern is highly probable as the virus has proven it can evolve to escape immunity in the current climate of infection. So far, the one documented way in which immune-escape variants have been found to evolve is in people who cannot clear the virus because of immunosuppression (see 10 and references therein). This leads to a prolonged infection where, in some cases, there are trace levels of anti-SARS-CoV-2 antibody that are not sufficient to clear the virus, but that possibly provide selective pressure for the virus to evolve antibody-escape mutations.…”

“…Immunosuppression is relatively common in Africa and elsewhere in a subset of people with advanced HIV disease, where poorly suppressed HIV infection over many years leads to severe damage to the immune response. A prolonged SARS-CoV-2 infection because of immunosuppression may persist for months and, surprisingly, may not lead to overt COVID-19 symptoms for much of its course 10 . The low disease severity during immunosuppression may be explained by the lack of a pathological inflammatory response against the virus.…”

Inactivated SARS-CoV-2 vaccine for people with HIV

“… 1 Moreover, increased SARS-CoV-2 mutation development has been reported in (African) HIV-1 infected patients. 2 Previous reports documented the safety and immunogenicity of mRNA-based SARS-CoV-2 vaccines in people infected with HIV. 3 , 4 , 5 This is less documented for inactivated SARS-CoV-2 vaccines.…”

“…As with mRNA vaccines, 2 , 3 , 4 , 5 Feng and colleagues 6 demonstrated that HIV-1 infected patients who were on stable ART, exhibited similar safety profiles as well as humoral and cellular immune responses as HIV-1 uninfected, after vaccination with an inactivated SARS-CoV-2 vaccine (BIBP-CorV). The investigators did not observe solicited adverse reactions among any of the study participants.…”

“… 10 For this reason HIV-1 patients could represent a source of such variants too. 2 The recent outbreak of Omicron originating from South Africa likely developed in (an) isolated HIV-1 patient(s). Africa as a continent hosts the majority of the world's HIV-1 patients (25 million), and development of novel SARS-CoV-2 variants that potentially result in higher morbidity and mortality than Omicron cannot be excluded.…”