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

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.

Automated summary

This study found that people with HIV (PWH) and HIV-negative individuals have similar SARS-CoV-2-specific antibody and T-cell responses. However, PWH had lower levels of SARS-CoV-2-specific memory CD8(+) T cells and higher levels of PD-1+ SARS-CoV-2-specific CD4(+) T cells. The CD4(+)/CD8(+) ratio was associated with PD-1 expression on SARS-CoV-2-specific CD8(+) T cells. HIV status strongly predicted the presence of postacute sequelae of SARS-CoV-2 infection (PASC) and certain inflammatory markers were associated with persistent symptoms.