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

Elife. 2021 Oct 5;10:e67397. doi: 10.7554/eLife.67397.


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.

Keywords: COVID-19; HIV; SARS-CoV-2; antiretroviral therapy; beta variant; infectious disease; microbiology; virus.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • CD4 Lymphocyte Count
  • COVID-19 / complications*
  • COVID-19 / immunology*
  • Female
  • HIV Infections / complications*
  • HIV Infections / immunology*
  • Humans
  • Immunity, Cellular*
  • Male
  • Middle Aged
  • SARS-CoV-2
  • Severity of Illness Index*
  • South Africa

Supplementary concepts

  • SARS-CoV-2 variants