Effect of HIV status and suppression on SARS-CoV-2 disease severity, vaccine response, and evolution.
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Date
2023
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Abstract
SARS-CoV-2 is a global pandemic that has infected 672,115,430 people globally
(https://coronavirus.jhu.edu/map.html, accessed 08.02.2023). SARS-CoV-2 is
continuously evolving, and new variants pose a continuous threat to curbing this
pandemic. Simultaneously, South Africa still struggles to control and manage an
enduring HIV pandemic. The synergistic interplay between these two pandemics has
necessitated an understanding of how these two viruses interact with each other to
tailor an intervention. This thesis investigated the effect of SARS-CoV-2 infection on
disease dynamics, differential disease outcomes, vaccine response, as well as SARSCoV-
2 evolution in people living with HIV (PLWH) with different levels of HIV
suppression and differing HIV suppression history.
The first study investigated the difference in disease severity amongst PLWH in the
first and second infection waves in South Africa. COVID-19. Thereafter, we explored
persistent SARS-CoV-2 infection in immunocompromised individuals and intra-host
evolution in a case study of a participant with advanced HIV infection. Here, we
illustrated that advanced HIV disease may lead to prolonged SARS-CoV-2 infection
and shedding of infectious virus and results in intra-host evolution of variant mutations,
making intra-host evolution in advanced HIV individuals a particular concern within the
South African context. Finally, we observed that effectively controlling HIV through
ART facilitates SARS-CoV-2 clearance. The last study widened the observations to
five participants with advanced HIV disease and showed that vaccination does induce
a potent neutralizing antibody response in this group, but only if HIV viremia is first
effectively suppressed with antiretroviral therapy. These findings highlight the
importance of suppressing HIV infection in eliciting an effective immune response
against, and preventing evolution of SARS-CoV-2.
Description
Doctoral Degree. University of KwaZulu-Natal, Durban.