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Women With Advanced HIV Carried COVID-19 Virus For 216 Days, Says New Study

According to a new medical research published as a preprint this June in the journal Medrxiv, a 36-year-old woman from South Africa with advanced HIV has been detected with 30 mutations of the COVID-19 virus between day 0 and 216 days. [1]

While some people effectively clear coronavirus within a few days or weeks, individuals with compromised immune systems, can shed high titer of COVID-19 infection for greater than six months.

Let's know more about the research and other related details.

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What To Know About Mutation Of COVID-19

The COVID-19, since its advent in December 2019, has mutated several times. A mutation is common in all types of microorganisms like viruses and bacteria and is considered a normal process of their life cycle.

Sometimes, the newly mutated forms of pathogens emerge and disappear, while sometimes, the new variant persists for longer and becomes more diverse.

In the case of COVID-19, scientists have monitored mutations in their spike proteins since its advent to date. According to a news report, the genetic diagnostic laboratories in India have reported over 24000 mutations in the last one year detected in around 7000 variants of COVID-19. [2]

However, there were only seven major variants or variants of concern in India, including B.1.617 and B.1.351 (Beta)[3], as reported by the Banaras Hindu University (BHU) and the Centre for Cellular and Molecular Biology (CCMB), while five notable variants in the US, according to the CDC. [4]

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About The Research

The study was carried out on a 36-year-old advanced HIV-positive woman from South Africa. She was admitted to the hospital in September 2020 with symptoms like cough, sore throat and dyspnoea. The symptoms started 12 days prior to the admission.

The woman was on antiretroviral therapy since 2006 and has recently been given a fixed dose of combination medication: tenofovir, emtricitabine and efavirenz. Her medical history also includes a single event of tuberculosis and chronic asthma.

She was diagnosed with COVID-19 with the help of RT-PCR on the day of admission, and had received oxygen via face mask and a six-day course of dexamethasone, an approved steroid by the WHO.

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During the hospital admission, she was enrolled on a study that was based on the immune response of COVID-19 patients with HIV infection.

Her condition was reviewed at the time of enrollment, and on day 20 and day 34, when she was asymptomatic. On day 71, she experienced chest tightness due to an oxygen drop from 96 to 76 per cent. She was then diagnosed with pneumocystis jiroveci pneumonia and was treated with co-trimoxazole and prednisone medications for 21 days.

On day 106, she reported only fatigue while on day 190, she was again found asymptomatic. On day 190, her treatment based on antiretroviral therapy was switched to a fixed dose of combinational medicines i.e. tenofovir, lamivudine and dolutegravir, and on day 206, the suppression in her HIV viral load was noticed.

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A total of six specimens were collected from day 6 to day 190. The result says that her RT-PCR report was positive at all times between days 0 to 216. Several mutations were reported along with high-level resistance to the antiretroviral drugs.

Some of the mutation types among 30 include D614G, G142V, D796Y, E484K, A1078V, K417T,
F490S, L455F, F456L, D427Y and N501Y.

The results say that despite moderate severity of HIV, the COVID-19 persisted for 216 days. Also, the mutation of the virus was not related to plasma therapy, but due to certain haematological conditions or immunosuppressive therapies or other chronic conditions.

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The data suggest that mutation of COVID-19 virus in HIV-positive women might have occurred due to pressure from impaired neutralising antibodies or, say, the impaired immune system. [5]

Note: The research is a preprint and has not been certified by peer review. The data available here has yet to be evaluated and so should not be used to guide clinical practice.

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Why Are People With HIV At Increased Risk Of COVID-19 Infection?

From the aforementioned case report, it can be said that people with advanced HIV are at increased risk of COVID-19 infection due to:

  • A low CD4 count or low count of immune cells.
  • Frequent episodes of other infections such as tuberculosis.
  • A high viral load due to compromised immunity.
  • Other AIDS-defining illnesses such as respiratory infections.
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    How To Prevent COVID-19 In HIV-Infected Individuals?

    • Maintain social distancing both indoors and outdoors.
    • Never go outside without a mask. Even wear a face mask while talking to someone at home.
    • Wash hands frequently with soap and water or alcohol-based sanitisers.
    • Avoid crowded places, even indoors.
    • Stock up with a 30-day supply of medications for your antiretroviral treatment.
    • Maintain cleanliness at home by using disinfectants.
    • Make sure you are well-vaccinated with flu, pneumonia and other important vaccines.
    • Avoid touching the face with unwashed or unsanitised hands.
    • While sneezing or coughing, cover your nose and mouth with a tissue or with your elbow. Throw the tissue immediately and wash your hands.
    • Meet with people outside the home while maintaining a safe distance.
    • Stay healthy by eating and exercising well.
    • Keep the home well-ventilated if you are visiting someone inside the house.
    • Stay in touch with your doctor in case you start observing certain COVID-19 symptoms such as fever or loss of smell.
    • Remember: The COVID-19 vaccines which are currently in use are believed to be safe for people with HIV. Get vaccinated soon after consulting your medical expert.

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      Common FAQs

      1. Is COVID-19 worse in people living with HIV?

      Some of the researches suggest that the risk of COVID-19 is more in people with compromised immune systems, including people with HIV. Researchers are still learning about the effect of COVID-19 in people with HIV.

      2. Can HIV treatment be used against COVID-19?

      Antiretroviral drugs which are used in HIV treatment are still under evaluation to be used for the prevention and treatment COVID-19. A recent report has shown that a HIV drug named Kaletra has been used for months in hospitals in Wuhan to treat COVID-19.

      3. Are people with HIV at higher risk for COVID-19 than other people?

      According to the CDC, people with HIV who are on antiretroviral therapy are at the same risk for COVID-19 compared to people who do not have HIV.