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A High Percentage of People with HIV on Antiretroviral Therapy Experience Detectable Low-Level Plasma HIV-1 RNA Following COVID-19
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Download the PDF here - (11/12/20)
Elevated COVID-19 outcomes among persons living with diagnosed HIV infection in New York State: Results from a population-level match of HIV, COVID-19, and hospitalization databases - (11/12/20)
Published:
19 November 2020
Michael J. Peluso1, Sonia Bakkour2, Michael P. Busch2, Steven G. Deeks3, Timothy J. Henrich4
1 Division of Infectious Diseases, University of California San Francisco, San Francisco, CA 2 Vitalant Research Institute, San Francisco, CA
3 Division of HIV, ID and Global Medicine, University of California San Francisco
4 Division of Experimental Medicine, University of California San Francisco
Corresponding Author:
Timothy J. Henrich, MD
Division of Experimental Medicine, University of California San Francisco 1001 Potrero Avenue, Building 3, Room 525A
San Francisco, CA 94706
Dear Editor,
We read with interest the recent article by Geretti et al. (October 2020) in which among adults under the age of 60 with acute SARS-CoV-2 infection, HIV seropostivity was shown to be significantly associated with 28-day mortality, even when adjusted for age and other potentially important factors (1). As the authors discuss in detail, these data contrast with an earlier study recently published in Clinical Infectious Diseases by Sigel et al. of people with HIV (PWH) who were hospitalized for acute SARS-CoV-2; in this study, there were no differences in adverse outcomes compared to a demographically similar HIV-seronegative group (1). While a number of case series and retrospective studies have also shown no differences in COVID-19 mortality or severity in PWH (2-7), there is emerging evidence for exacerbations of lymphocyte dysfunction and aberrant immune activation in the setting of SARS-CoV-2/HIV coinfection (8). Furthermore, COVID-19 often leads to increased markers of immune activation, inflammation and immune dysregulation, regardless of concomitant chronic infections (9). It is therefore plausible that, in addition to HIV modulating SARS-CoV- 2 infection, COVID-19 may have a short or longer-term impact on HIV disease following acute SARS-CoV-2 infection in PWH on effective antiretroviral therapy (ART). As a result, we sought to identify if SARS-CoV-2/HIV-1 coinfection may lead to an increase the frequency of detectable, but low-level plasma HIV-1 RNA levels that would not necessarily be detected by clinical viral load assays.
We tested large volumes of plasma for HIV-1 RNA using a highly sensitive single copy assay (SCA) from 12 PWH on ART using a replicate (9x) technology as previously described (10) with PCR-confirmed, convalescent SARS-CoV-2 infection a median of 37 days since onset of COVID-19 symptoms, and from 17 PWH on ART with plasma collection prior to COVID-19 (March 2018 – October 2019). Table 1 summarizes participant demographics, ART use and low-level residual HIV-1 RNA. Whereas 83.3 percent of PWH had detectable HIV-1 RNA by SCA, only 58.8 percent of PWH had detectable HIV-1 RNA prior to the COVID-19 pandemic despite similar input plasma volumes. The median HIV-1 RNA copies/mL was 1.59 in PWH with recent COVID-19 compared with 0.38 in the pre-COVID-19 group. Four COVID-19+ participants that all had detectable blips had subsequent testing a median of 75 days after onset of symptoms (interquartile range: 58-90 days); three had persistence of detectable HIV-1 plasma RNA (median 1.95 copies/mL, IQR 0.1-14.53).
Although sample sizes were modest and there were no significant differences between COVID-19+ and pre-COVID-19 groups, the above results suggest that lasting perturbations of immune function and systemic inflammation may impact the natural course of HIV infection, potentially months following HIV infection. Whereas these low-level viremic episodes are unlikely to have direct clinical implications for patients, larger, prospective studies will be needed in order to fully understand the long-term impact of COVID-19 on HIV dynamics and viral immune responses.
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