Original article from LA Times
As COVID-19 collides with HIV/AIDS, the pandemic may be taking an ominous turn
As the world’s less affluent countries scramble for COVID-19 vaccine and contend with deadly surges of the disease, researchers in South Africa have just documented an ominous development: the collision of the pandemic with HIV/AIDS.
Geneticists and infectious disease specialists there have uncovered potentially dangerous coronavirus mutations in a 36-year-old woman with uncontrolled HIV who was unable to shake the SARS-CoV-2 virus for close to eight months. The driving force behind the patient’s rapid accumulation of genetic changes is probably her impaired immune response due to her unsuccessfully treated HIV, the researchers said.
The case highlights a difficult truth: that affluent nations racing to vaccinate their own populations will remain vulnerable as long as the coronavirus is spreading and mutating in low- and middle-income countries, where lack of vaccine has kept COVID-19 immunization rates low. That's especially true in countries like South Africa, where HIV infections are common but often undetected.
“This underscores the advantage that this virus has until we can put the brakes on it, and we have to put the brakes on it globally,” said Dr. Bruce Walker, founding director of the Ragon Institute, an immunology research center in Boston.
While the South African patient was diagnosed with HIV back in 2006, doctors had been unable to control her viral load with standard antiretroviral therapy, and her immune system’s population of CD4+ T cells — which may play a role in clearing coronavirus infection — were very low.
For 216 days, the woman continued to test positive for the SARS-CoV-2 virus. She was hospitalized with moderate illness for nine days in September soon after she contracted the coronavirus, but she never became severely ill with COVID-19.
Still, the coronavirus that lingered in her body underwent 13 genetic changes related to its crucial spike protein, along with at least 19 other genetic shifts elsewhere that could change the behavior of the virus.
The new findings raise the specter that HIV/AIDS — a 40-year-old scourge that has killed 32 million worldwide — could complicate efforts to eradicate a COVID-19 pandemic that has killed more than 3.5 million in less than a year and a half.
Until the South African patient, there has been little evidence to suggest that HIV-infected people could complicate the pandemic’s trajectory. HIV-positive people were not known to be more likely to become infected with the coronavirus. And research had suggested they did not suffer worse medical consequences of COVID-19.
But if her case turns out to be typical, that picture could change: HIV patients whose infections are not controlled with medication could "become a factory of variants for the whole world," said Tulio de Oliveira, a geneticist at the University of KwaZulu-Natal in Durban, who led the new research.
Worldwide, roughly 8 million people are thought to be infected with HIV but unaware of their status. An additional 1.7 million are on antiretroviral medications that aren't working well.
The prospect that close to 10 million patients’ uncontrolled HIV could spawn new coronavirus variants has wide-ranging implications.
“This is a syndemic,” said Dr. Jonathan Li, using a term that describes the confluence of two epidemics with the potential to worsen outcomes for both.
An infectious disease specialist at Brigham & Women's Hospital in Boston, Li was one of the first to document the proliferation of significant coronavirus mutations in a single immunocompromised patient who could not clear his coronavirus infection for more than five months and succumbed to COVID-19 last summer. His case put doctors on notice that such patients might be powerful incubators of viral variants.
Li’s largest patient population is people with HIV. From the time that potentially dangerous coronavirus variants began emerging, he said he’s had his “fingers crossed” that people with HIV would not turn out to be a source of mutations that could make the virus more transmissible or harder to prevent or treat.
“This is one of the first reports that some of my fears may be coming to fruition,” said Li, who was not involved in the new research.
It’s not yet clear whether any of the mutations she harbored spread to other people. But the researchers said it's probably not a coincidence that dangerous new variants have emerged from populations like those in South Africa's KwaZulu Natal province, where more than 1 in 4 adults has HIV.
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https://www.yahoo.com/news/covid-19-collides-hiv-aids-100051925.html