Can Uncontrolled HIV Cause COVID Mutations?

A South African woman with uncontrolled HIV developed possibly dangerous mutations last year of SARS-CoV-2, the coronavirus that causes COVID-19, indicating a potential collision between the two pandemics, researchers say.

Before this case came to light, scientists had found that HIV did not heighten the risk of contracting COVID, nor did it cause more serious symptoms. But if there are many others like the South African patient, people with uncontrolled HIV could “become a factory of variants for the whole world,” Tulio de Oliveira, a geneticist at the University of KwaZulu-Natal in Durban and lead researcher on the case, told the Los Angeles Times.

Treatment with antiretroviral drugs suppresses the viral load in most people with HIV, but it did not do so for the South African woman, who was diagnosed with HIV in 2006. As a result, she had a low level of T cells, which help the immune system fight off various infections, possibly including COVID-19.

She tested positive for SARS-CoV-2 for 216 days and developed a moderate illness for which she was hospitalized for nine days last September. She never became seriously ill, but the coronavirus remaining 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 Times reports.

The woman, who is now 36, was participating in a study of the effect of COVID-19 on people with HIV; if she had not been in the study, it’s likely that neither she nor scientists would have known about the variants. After the study had been going on about six months, doctors switched her antiretroviral meds, which finally resulted in suppression of her HIV, and she was soon cleared of the coronavirus as well. The doctors plan to test blood samples from four others in the study who had coronavirus infections that lasted more than a month.

Her experience raises the possibility that the coronavirus could mutate in ways that make it deadlier and underlines the need to get people with HIV diagnosed and on effective antiretroviral treatment as soon as possible. Scientists estimate that 8 million people worldwide are living with HIV and don’t know it, and another 1.7 million are on treatment that’s not effective. This is a particular problem in developing countries.

Expanding HIV testing and treatment “would reduce mortality from HIV, reduce transmission of HIV, and also reduce the chance of generating new COVID variants that could cause other waves of infections,” de Oliveira said.