Some uncontrolled HIV infections, with their associated lowering of defenses, can become a breeding ground for the appearance of worrying new variants of the coronavirus, as confirmed by five cases detected in South Africa and the United Kingdom of people without medication. In one of them, a 22 year old woman with immunodeficiency—who lived in rural South Africa and had not had access to a covid vaccine—suffered a parallel SARS-CoV-2 infection for nine months. In his weakened body, the coronavirus had time to evolve and accumulate 21 mutations, some of them associated with a greater ability to escape human defenses.
Experts warn that the covid virus can still give surprises. The omicron variant of the coronavirus, with fifty mutations, was detected in South Africa just over two months ago and quickly became the dominant one in the world, but the usual version is already being displaced by another even more transmissible one, called BA. two. In the world they continue to register over 50,000 deaths by covid confirmed each week.
The 22-year-old woman, treated at a Cape Town hospital, overcame chronic SARS-CoV-2 infection thanks to adequate treatment against HIV, which recovered her lost defenses, according to the virologist Tongai Maponga, member of the medical team. “This case shows that some of the challenges associated with SARS-CoV-2 can be addressed by addressing other health problems, such as HIV,” says Maponga from Stellenbosch University. South Africa is the country with the most people affected by the AIDS virus: almost eight million. One in five citizens lives with HIV. The 22-year-old woman was born with the virus.
South African scientists have been warning for months that passivity in the face of the covid pandemic in countries with a high incidence of HIV can favor the appearance of new variants of the coronavirus, more transmissible or even capable of evading the defenses produced by vaccines. A new study, published Jan. 14, estimates that 80,000 people living with HIV in South Africa are eligible for chronic SARS-CoV-2 infections, in which the coronavirus can accelerate its progression. The work —led by the biologist Alex Sigal, from the University of KwaZulu-Natal—details the case of a woman in her thirties with HIV and a parallel infection with the coronavirus for more than six months. The covid virus accumulated several disturbing mutations at that time, such as those called Erik (E484K) and Nelly (N501Y), associated with a greater ability to circumvent human defenses.
In sub-Saharan Africa you have the highest incidences of HIV and a population that does not have access to vaccines against covid
Teresa Cutiño, virologist
The Mexican virologist Teresa Cutino believes that the appearance of worrying variants of the coronavirus will be “very common” in countries with a very high incidence of HIV. Cutino works at Barts Health, one of the largest public hospital groups in England. Your team just posted three patient cases with advanced HIV disease and chronic coronavirus infection, in which mutations associated with increased transmissibility and increased ability to evade the immune system emerged. “In sub-Saharan Africa you have the highest incidences of HIV and a population that does not have access to vaccines against covid. You have all the elements for new variants to be produced”, he warns.
Cutiño considers it “obscene” that some rich countries are already offering fourth doses of the vaccine while there are poor countries without access to the first injections. In Spain, 82% of the population is already vaccinated, compared to 28% in South Africa and 11% in the entire African continent, according to the count from the University of Oxford. In Burundi and the Democratic Republic of the Congo, less than 0.5% of citizens are vaccinated against covid. And in Africa they live more than 25 million people with HIV, two-thirds of the world total.
The Mexican scientist recalls that the new variants of the coronavirus can also arise in other people with very low defenses, not only in those who live with uncontrolled HIV: patients who have received a transplant, cancer patients undergoing chemotherapy, people with immunodeficiencies of birth. In the scientific literature there are several cases of chronic SARS-CoV-2 infections that lasted months, such as those of a 60-year-old man with mantle cell lymphoma and that of a 71-year-old woman with chronic lymphocytic leukemia, ambos en EE UU.
The omicron variant of the coronavirus is so different from the previous ones that some scientists, such as the Danish biologist Kristian Andersen, came to hypothesize that the virus had jumped to animals and had returned to humans months later, already transformed. Andersen, a researcher at the Scripps Institute (San Diego, USA) who is one of the leading experts on the evolution of the coronavirus, has recognized in their social networks who has changed his mind after seeing the new studies in people with uncontrolled HIV. Now he believes “90%” that the most divergent variants have arisen in patients with chronic infections.
Virologist Tongai Maponga appeals not to “feed the stigma” of people with HIV. Patients receiving antiretroviral treatment have undetectable levels of virus and can live normally. But nevertheless, 10 million of the almost 38 million people living with HIV in the world do not receive anti-virus therapy, according to the Joint United Nations Program on HIV/AIDS (UNAIDS). Six million of these citizens without treatment they are in africa.
The two pandemics, HIV and covid, feed off each other. The chaos caused by SARS-CoV-2 in the last two years has made it difficult to access treatments against the AIDS virus. People with HIV also have twice the risk of dying from covid than the general population, according to studies in England and South Africa cited by UNAIDS.
Maponga and her colleagues call for COVID-19 vaccination of people with HIV to be prioritized and for access to antiretroviral treatments to be facilitated. The virologist emphasizes that there is no proof that the coronavirus with 21 mutations detected in the South African girl with HIV has reached the rest of the population, but believes that the case offers an “essential lesson” to the world. “We cannot afford to ignore other health challenges – such as HIV, tuberculosis, viral hepatitis, malaria and cancer – while we focus on covid,” warns Maponga.
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