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Postacute sequelae and adaptive immune responses in people with HIV recovering from SARS-COV-2 infection
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AIDS oct 1 2022
Peluso, Michael J
HIV status was strongly associated with PASC (odds ratio 4.01, P = 0.008).
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.
Participants reported a wide array of PASC symptoms (Table 2). A larger proportion of PWH reported certain symptoms, such as fatigue, gastrointestinal and certain neurocognitive symptoms, and issues with sleep.
PWH had 4.01-fold higher odds of PASC (95% CI 1.45-11.1; P = 0.008; 82.8 vs. 54.4%), in a model controlling for time since infection, hospitalization, and age. This was maintained when defining PASC as three or more symptoms in comparison to fewer than three symptoms [adjusted odds ratio (AOR) 2.72; 1.08-6.88; P = 0.03; 59.8 vs. 33.6%]. PWH reported more symptoms overall [median 3 (IQR 1-6) versus median 1 (IQR 0-5), P = 0.02], and those with HIV had a 1.91-fold higher number of PASC symptoms than those without HIV (P = 0.02).
We observed that HIV status was strongly associated with PASC, raising concerns that this condition might be common among PWH recovering from COVID-19. Higher levels of inflammation were associated with PASC. Finally, we observed differences in SARS-CoV-2-specific CD4+ and CD8+ T cells that might have implications for long-term immunity conferred by natural infection. This study adds to the limited data examining SARS-CoV-2-specific immune responses in PWH and underscores the need for larger and more detailed studies of PASC in PWH.
PASC may be driven, at least in part, by residual or ongoing inflammation following SARS-CoV-2 infection [9,10]. ART-treated HIV is a chronic inflammatory condition associated with persistent immune activation [15-18]. Further immune perturbations related to COVID-19 may, therefore, lead to a higher prevalence of PASC among PWH. Additional factors could also predispose PWH to PASC, such as autoimmunity [33], localized tissue inflammation [34], human herpesvirus reactivation [13], and microvascular dysfunction [14]. Other comorbidities including substance use and metabolic disorders may further contribute. Regardless of mechanism, our observation suggests that PASC may be especially common in PWH and emphasizes the need for studies of PASC in this population.
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