Individuals With Advanced HIV May Not Achieve Viral Clearance of SARS-CoV-2, Leading to Extensive Mutations


Growing evidence suggests that failure to clear SARS-CoV-2 infection in patients with advanced HIV can create conditions leading to the evolution of dangerous viral mutations, according to data presented at the 2021 European Congress on Clinical Microbiology & Infectious Diseases (ECCMID). Further, the investigators said their findings suggest the beta SARS-CoV-2 variant, first identified in South Africa, leads to more severe disease in patients living with HIV.

“Evolved mutations lead to escape from neutralization, which means antibodies made as a result of previous natural infection or vaccination would work less well to protect you from a new infection,” said session presenter Alex Sigal, PhD, in a press release. “SARS-CoV-2 may mutate extensively within one person if infection persists.”

Because viral clearance is compromised if HIV is allowed to replicate for an extended period of time—resulting in extensive damage to the immune system—controlling HIV with antiretroviral therapy may be critical to preventing this type of viral evolution in SARS-CoV-2 in patients with advanced HIV. Sigal presented a case study in his talk at ECCMID of a patient with advanced HIV who tested positive for SARS-CoV-2 for 216 days, despite only having mild COVID-19 illness.

According to the investigators, the use of genomic sequencing revealed changes in the patient’s viral population over time. These changes included multiple mutations at key sites, including the spike protein domain used by SARS-CoV-2 to enter human cells.

This evolved virus was shown through testing to have variant-like properties in terms of its ability to escape antibodies. Further, the patient was only able to clear their SARS-CoV-2 infection after their HIV infection was suppressed through the use of effective antiretroviral therapy.

“Such findings underline the need to make sure everyone living with HIV has appropriate treatment,” Sigal said in the release. “If not, it is possible that potentially more potent variants than the ones circulating now could emerge from people whose immune systems are severely damaged.”


Highly mutated SARS-CoV-2 emerged from someone living with advanced HIV who could not clear SARS-CoV-2 until their HIV infection was suppressed with effective antiretroviral therapy [news release]. EurekAlert; July 9, 2021. Accessed July 12, 2021.

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