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.

Background

The intersection between the SARS-CoV-2 and HIV epidemics has gained increased attention [1]. Although early studies did not show differences in acute coronavirus disease 2019 (COVID-19) associated with HIV status [2, 3], larger studies show that people with HIV (PWH) are at higher risk for adverse outcomes [4, 5]. Data on SARS-CoV-2-specific adaptive immune responses in PWH remain sparse; however, with one study showing less robust immune responses among PWH [6] but another [7] suggesting similar responses. Furthermore, there is growing recognition of the clinical burden of postacute sequelae of SARS-CoV-2 infection (PASC, including ‘long COVID’)[8], but this condition remains poorly understood, especially in PWH.