HIV status alters disease severity and immune cell responses in beta variant SARS-CoV-2 infection wave

There are conflicting reports on the effects of HIV on COVID-19. Here we analyzed disease severity and immune cell changes during and after SARS-CoV-2 infection in 236 participants from South Africa, of which 39% were people living with HIV (PLWH), during the first and second (beta dominated) infection waves. The second wave had more PLWH requiring supplemental oxygen relative to HIV negative participants. Higher disease severity was associated with low CD4 T cell counts and higher neutrophil to lymphocyte ratios (NLR). Yet, CD4 counts recovered and NLR stabilized after SARS-CoV-2 clearance in wave 2 infected PLWH, arguing for an interaction between SARS-CoV-2 and HIV infection leading to low CD4 and high NLR. The first infection wave, where severity in HIV negative and PLWH was similar, still showed some HIV modulation of SARS-CoV-2 immune responses. Therefore, HIV infection can synergize with the SARS-CoV-2 variant to change COVID-19 outcomes.

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HIV infection alters SARS-CoV-2 responsive immune parameters but not clinical outcomes in COVID-19 disease

10.1101/2020.11.23.20236828 ◽

2020 ◽

Cited By ~ 2

Author(s):

Farina Karim ◽

Inbal Gazy ◽

Sandile Cele ◽

Yenzekile Zungu ◽

Robert Krause ◽

...

Keyword(s):

Immune Response ◽

T Cell ◽

Hiv Infection ◽

Disease Severity ◽

Immune Cell ◽

Killer Cell ◽

People Living With Hiv ◽

Antibody Secreting Cell ◽

The Impact ◽

Hiv Negative

AbstractHIV infection alters the immune response and can compromise protective immunity to multiple pathogens following vaccination. We investigated the impact of HIV on the immune response to SARS-CoV-2 using longitudinal samples from 124 participants from KwaZulu-Natal, South Africa, an area of extremely high HIV prevalence. 44% of participants were people living with HIV (PLWH) and commonly had other co-morbidities, including obesity, hypertension, and diabetes. The majority of PLWH but not HIV negative participants showed CD8 T cell expansion above the normal range post-SARS-CoV-2. Yet, in participants with HIV suppressed by antiretroviral therapy (ART), CD8 expansion was associated with milder COVID-19 disease. There were multiple differences in T cell, B cell, and natural killer cell correlations in PLWH compared to HIV negative participants, including lower tissue homing CXCR3+ CD8 T cells in the presence of SARS-CoV-2 RNA in PLWH but not HIV negative and a pronounced early antibody secreting cell (ASC) expansion in HIV negative but not PLWH. These changes were COVID-19 associated: low CXCR3 correlated with increased COVID-19 disease severity across groups, and high ASC correlated with increased disease severity in HIV negative participants and waned when SARS-CoV-2 was cleared. Despite the altered response of immune cell subsets, COVID-19 disease in PLWH was mostly mild and similar to HIV negative participants. This likely reflects the heterogeneity of an effective COVID-19 immune response. Whether the differences in immune cell dynamics in PLWH will lead to different long-term consequences or compromise vaccination is yet to be determined.

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HIV Infection and the Risk of World Health Organization–Defined Sudden Cardiac Death

Journal of the American Heart Association ◽

10.1161/jaha.121.021268 ◽

2021 ◽

Vol 10 (18) ◽

Author(s):

Matthew S. Freiberg ◽

Meredith S. Duncan ◽

Charles Alcorn ◽

Chung‐Chou H. Chang ◽

Suman Kundu ◽

...

Keyword(s):

Viral Load ◽

Hiv Infection ◽

World Health ◽

People Living With Hiv ◽

Hiv Viral Load ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Health Organization ◽

Living With Hiv ◽

Cd4 Cell

Background People living with HIV have higher sudden cardiac death (SCD) rates compared with the general population. Whether HIV infection is an independent SCD risk factor is unclear. Methods and Results This study evaluated participants from the Veterans Aging Cohort Study, an observational, longitudinal cohort of veterans with and without HIV infection matched 1:2 on age, sex, race/ethnicity, and clinical site. Baseline for this study was a participant's first clinical visit on or after April 1, 2003. Participants were followed through December 31, 2014. Using Cox proportional hazards regression, we assessed whether HIV infection, CD4 cell counts, and/or HIV viral load were associated with World Health Organization (WHO)–defined SCD risk. Among 144 336 participants (30% people living with HIV), the mean (SD) baseline age was 50.0 years (10.6 years), 97% were men, and 47% were of Black race. During follow‐up (median, 9.0 years), 3035 SCDs occurred. HIV infection was associated with increased SCD risk (hazard ratio [HR], 1.14; 95% CI, 1.04–1.25), adjusting for possible confounders. In analyses with time‐varying CD4 and HIV viral load, people living with HIV with CD4 counts <200 cells/mm 3 (HR, 1.57; 95% CI, 1.28–1.92) or viral load >500 copies/mL (HR, 1.70; 95% CI, 1.46–1.98) had increased SCD risk versus veterans without HIV. In contrast, people living with HIV who had CD4 cell counts >500 cells/mm 3 (HR, 1.03; 95% CI, 0.90–1.18) or HIV viral load <500 copies/mL (HR, 0.97; 95% CI, 0.87–1.09) were not at increased SCD risk. Conclusions HIV infection is associated with increased risk of WHO‐defined SCD among those with elevated HIV viral load or low CD4 cell counts.

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Does HIV impact susceptibility to COVID-19 (SARS-CoV-2) infection and pathology? A review of the current literature

10.1101/2020.12.04.20240218 ◽

2020 ◽

Author(s):

Elnara Aghakishiyeva ◽

Derek Macallan

Keyword(s):

New York ◽

Hiv Infection ◽

People Living With Hiv ◽

Risk Of Infection ◽

Relative Risks ◽

Confounding Variables ◽

The Uk ◽

Living With Hiv ◽

Adequate Data ◽

Hiv Negative

AbstractObjectivesGiving appropriate guidance to people living with HIV (PLWH) during the COVID-19 pandemic depends on having adequate data to inform recommendations. Several studies have now been published which inform such advice. The objective of this study was to collate this information and review the implications of emerging data.MethodsWe performed a systematic literature search of studies relating COVID-19 to HIV infection from the beginning of the pandemic to end of November 2020. We included both published and pre-published manuscripts and analysed papers according to whether they primarily informed risk of infection or risk of adverse outcome.Results68 papers (including 11 pre-prints) were identified. In terms of risk of infection, it appears that PLWH are no more or less likely to become infected with COVID-19. In terms of outcomes and mortality, most early small studies did not demonstrate an increase in mortality compared to background populations. However, several larger, more recent studies from South Africa, New York and two from the UK demonstrate higher mortality among PLWH when results are adjusted for other risk factors, giving relative risks of 2.1, 1.2, 1.7 and 2.3 respectively. Apparently conflicting results may arise from differences between studies in their power to account for cofactors and confounding variables. HIV-positive non-survivors tend to be younger and have fewer comorbidities than their HIV-negative counterparts; mortality may be higher in PLWH with low CD4 counts.ConclusionsAlthough the literature appears conflicting, large studies which account for covariates strongly suggest that HIV infection increases COVID-19 mortality.

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Excess burden of age-associated comorbidities among people living with HIV in British Columbia, Canada: a population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2020-041734 ◽

2021 ◽

Vol 11 (1) ◽

pp. e041734

Author(s):

Ni Gusti Ayu Nanditha ◽

Adrianna Paiero ◽

Hiwot M Tafessu ◽

Martin St-Jean ◽

Taylor McLinden ◽

...

Keyword(s):

British Columbia ◽

Cohort Study ◽

Population Based ◽

Age At Diagnosis ◽

Secondary Outcome ◽

People Living With Hiv ◽

Prevalence Trends ◽

Living With Hiv ◽

Negative Controls ◽

Hiv Negative

ObjectivesAs people living with HIV (PLWH) live longer, morbidity and mortality from non-AIDS comorbidities have emerged as major concerns. Our objective was to compare prevalence trends and age at diagnosis of nine chronic age-associated comorbidities between individuals living with and without HIV.Design and settingThis population-based cohort study used longitudinal cohort data from all diagnosed antiretroviral-treated PLWH and 1:4 age-sex-matched HIV-negative individuals in British Columbia, Canada.ParticipantsThe study included 8031 antiretroviral-treated PLWH and 32 124 HIV-negative controls (median age 40 years, 82% men). Eligible participants were ≥19 years old and followed for ≥1 year during 2000 to 2012.Primary and secondary outcome measuresThe presence of non-AIDS-defining cancers, diabetes, osteoarthritis, hypertension, Alzheimer’s and/or non-HIV-related dementia, cardiovascular, kidney, liver and lung diseases were identified from provincial administrative databases. Beta regression assessed annual age-sex-standardised prevalence trends and Kruskal-Wallis tests compared the age at diagnosis of comorbidities stratified by rate of healthcare encounters.ResultsAcross study period, the prevalence of all chronic age-associated comorbidities, except hypertension, were higher among PLWH compared with their community-based HIV-negative counterparts; as much as 10 times higher for liver diseases (25.3% vs 2.1%, p value<0.0001). On stratification by healthcare encounter rates, PLWH experienced most chronic age-associated significantly earlier than HIV-negative controls, as early as 21 years earlier for Alzheimer’s and/or dementia.ConclusionsPLWH experienced higher prevalence and earlier age at diagnosis of non-AIDS comorbidities than their HIV-negative controls. These results stress the need for optimised screening for comorbidities at earlier ages among PLWH, and a comprehensive HIV care model that integrates prevention and treatment of chronic age-associated conditions. Additionally, the robust methodology developed in this study, which addresses concerns on the use of administrative health data to measure prevalence and incidence, is reproducible to other settings.

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Causes and outcomes of hospitalizations among people living with HIV in Georgia’s referral institution, 2012–2017

International Journal of STD & AIDS ◽

10.1177/0956462420984701 ◽

2021 ◽

Vol 32 (7) ◽

pp. 662-670

Author(s):

Nino Rukhadze ◽

Ole Kirk ◽

Nikoloz Chkhartishvili ◽

Natalia Bolokadze ◽

Lali Sharvadze ◽

...

Keyword(s):

Multivariate Analysis ◽

Clinical Immunology ◽

Fatal Outcome ◽

Cd4 Count ◽

People Living With Hiv ◽

Lethal Outcome ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Living With Hiv ◽

Cd4 Cell

We assessed trends in causes and outcomes of hospitalization among people living with HIV (PLWH) admitted to the Infectious Diseases, AIDS and Clinical Immunology Research Center (IDACIRC) in Tbilisi, Georgia. Retrospective analysis included adult PLWH admitted to IDACIRC for at least 24 h. Internationally validated categorization was used to split AIDS admissions into mild, moderate, and severe AIDS. A total of 2085 hospitalizations among 1123 PLWH were registered over 2012–2017 with 65.1% (731/1123) of patients presenting with CD4 count <200. Of 2085 hospitalizations, 931 (44.7%) were due to AIDS-defining illnesses. In 2012, AIDS conditions accounted for 50.3% of admissions compared to 41.6% in 2017 ( p = 0.16). Overall, 167 hospitalizations (8.0%) resulted in lethal outcome. AIDS admissions had higher mortality than non-AIDS admissions (11.5% vs 5.2%, p < 0.0001). Among 167 deceased patients, 137 (82.0%) had CD4 count <200 at admission. In multivariate analysis, factors significantly associated with mortality included severe AIDS versus non-AIDS admission (OR 2.81, 95% CI: 1.10–7.15), CD4 cell counts <50 (OR 4.34, 95% CI: 2.52–7.47), and 50–100 (OR 2.37, 95% CI: 1.27–4.42) versus >200. Active AIDS disease remains a significant cause of hospitalization and fatal outcome in Georgia. Earlier diagnosis of HIV is critical for decreasing AIDS hospitalizations and mortality.

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Exploring the Factors Considered by People Living with HIV and Their Partners during Preconception

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325957416682089 ◽

2016 ◽

Vol 16 (3) ◽

pp. 239-246 ◽

Cited By ~ 3

Author(s):

V. Logan Kennedy ◽

Micaela Collins ◽

Mark H. Yudin ◽

Lena Serghides ◽

Sharon Walmsley ◽

...

Keyword(s):

Logit Model ◽

Hiv Transmission ◽

Horizontal Transmission ◽

People Living With Hiv ◽

Relative Importance ◽

Hiv Status ◽

Ordered Logit Model ◽

Living With Hiv ◽

Shed Light ◽

Hiv Negative

Data are lacking on factors that may impact conception-related decision-making among individuals living with HIV. This study’s aim was to shed light on these considerations. Participants were invited to complete a survey on preconception considerations. A rank-ordered logit model was fit to estimate the relative importance of listed consideration factors; the interaction of HIV status and the factors was assessed. Fifty-nine participants living with HIV and 18 partners (11 HIV-negative participants and 7 living with HIV) were included. Risk of vertical and horizontal HIV transmission and the effect of antiretroviral therapy on the fetus were the top considerations. However, individuals living with HIV prioritized vertical transmission, whereas HIV-negative participants prioritized horizontal transmission. Other factors of importance were probability of conception, stress of trying to conceive, cost associated with fertility clinics, and stigma associated with certain conception methods. This study builds our understanding of the preconception considerations for people living with HIV.

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