Postacute sequelae and adaptive immune responses in people with HIV recovering from SARS-COV-2 infection

AIDS. 2022 Oct 1;36(12):F7-F16. doi: 10.1097/QAD.0000000000003338. Epub 2022 Jul 18.


Background: Limited data are available on the long-term clinical and immunologic consequences of SARS-CoV-2 infection in people with HIV (PWH).

Methods: We measured SARS-CoV-2-specific humoral and cellular responses in people with and without HIV recovering from COVID-19 ( n = 39 and n = 43, respectively) using binding antibody, surrogate virus neutralization, intracellular cytokine staining, and inflammatory marker assays. We identified individuals experiencing postacute sequelae of SARS-CoV-2 infection (PASC) and evaluated immunologic parameters. We used linear regression and generalized linear models to examine differences by HIV status in the magnitude of inflammatory and virus-specific antibody and T-cell responses, as well as differences in the prevalence of PASC.

Results: Among PWH, we found broadly similar SARS-CoV-2-specific antibody and T-cell responses as compared with a well matched group of HIV-negative individuals. PWH had 70% lower relative levels of SARS-CoV-2-specific memory CD8 + T cells ( P = 0.007) and 53% higher relative levels of PD-1+ SARS-CoV-2-specific CD4 + T cells ( P = 0.007). Higher CD4 + /CD8 + ratio was associated with lower PD-1 expression on SARS-CoV-2-specific CD8 + T cells (0.34-fold effect, P = 0.02). HIV status was strongly associated with PASC (odds ratio 4.01, P = 0.008), and levels of certain inflammatory markers (IL-6, TNF-alpha, and IP-10) were associated with persistent symptoms.

Conclusion: We identified potentially important differences in SARS-CoV-2-specific CD4 + and CD8 + T cells in PWH and HIV-negative participants that might have implications for long-term immunity conferred by natural infection. HIV status strongly predicted the presence of PASC. Larger and more detailed studies of PASC in PWH are urgently needed.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Antibodies, Viral / metabolism
  • CD4-Positive T-Lymphocytes
  • COVID-19* / complications
  • HIV Infections* / complications
  • HIV Infections* / metabolism
  • Humans
  • Immunologic Memory
  • Programmed Cell Death 1 Receptor / metabolism
  • SARS-CoV-2


  • Antibodies, Viral
  • Programmed Cell Death 1 Receptor