Background
SARS-CoV-2 infection can be associated with immunologic dysfunction and might serve as a ‘second hit’ to immune function in people with HIV (PWH) despite suppression with antiretroviral therapy (ART). We leveraged the RV254 Thai cohort to examine the trajectory of immunologic and virologic parameters 1.5 years pre- and post-COVID-19 in PWH on stable ART initiated during acute HIV infection (AHI).
Methods
RV254 participants are enrolled during AHI (Fiebig I-V), initiated ART within days, and undergo serial longitudinal blood (CD4+ & CD8+ T-cell counts, HIV RNA) tests. In participants on ≥ 48 weeks of stable ART with documented COVID-19, immunologic measures 1.5 years pre- to post-COVID-19 were regressed on time using linear mixed models. Time in years since COVID-19 diagnosis was entered as a linear spline with knots at the time of COVID-19 diagnosis and 0.25-year intervals thereafter; each time point after diagnosis was compared with the value at the time of diagnosis. Rates of detectable viral load (> 50 copies/ml) before and after COVID-19 diagnosis were compared using Poisson regression generalized estimating equations.
Results
Between 4/2021 and 9/2022, 262 participants on ≥48 weeks of stable ART (97% males, median age 32 [interquartile range 29-38]) were diagnosed with COVID-19. Of these, 213 (82.1%) were diagnosed during the Omicron wave; 224 (85.5%) received ≥2 doses of COVID-19 vaccines prior to diagnosis; 4 (1.5%) required supplemental oxygen; 1 (0.4%) required intensive care and there were no fatalities. Compared with values at the time of COVID-19 diagnosis, there were significant declines in estimated CD4+ T-cell count (from 710.77) at 6 (679.62, p=0.030) and 9 (668.14, p=0.008) months and the CD4+/CD8+ T-cell ratio (from 1.13) at 3 (1.09, p=0.019), 9 (1.07, p<0.001), and 12 (1.08, p=0.006) months after diagnosis (Figure 1). CD8+ T-cell count was stable over this period. Estimated rates of detectable viral load per year decreased post-COVID (5.6% vs. 2.2%, p=0.04).
Conclusions
In this cohort of young, mostly male PWH with viral suppression after early ART, we observed mild but significant changes in the trajectory of CD4+ T-cell count and CD4/CD8 ratio up to one year after COVID-19. Detectable viral load rates decreased post-COVID-19 but CD8+ T-cell count remained stable. Longer follow-up and additional studies to disentangle the effects of COVID-19 vaccination and reinfections are ongoing to determine the impact of COVID-19 on the immunologic and virologic outcomes in PWH.