Immuno-Suppressed Patients Take Longer to Clear Covid-19, Allowing Time for More Mutations and New Variants

(p. 14) When people with H.I.V. are prescribed an effective antiretroviral and take it consistently, their bodies almost completely suppress the virus. But if people with H.I.V. aren’t diagnosed, haven’t been prescribed treatment, or don’t, or can’t, take their medicines consistently each day, H.I.V. weakens their immune systems. And then, if they catch the coronavirus, it can take weeks or months before the new virus is cleared from their bodies.

When the coronavirus lives that long in their systems, it has the chance to mutate and mutate and mutate again. And, if they pass the mutated virus on, a new variant is in circulation.

“We have reasons to believe that some of the variants that are emerging in South Africa could potentially be associated directly with H.I.V.,” said Tulio de Oliveira, the principal investigator of the national genetic monitoring network.

In the first days of the pandemic, South Africa’s health authorities were braced for soaring death rates of people with H.I.V. “We were basically creating horror scenarios that Africa was going to be decimated,” said Salim Abdool Karim, an epidemiologist who heads the AIDS institute where KRISP is housed. “But none of that played out.” The main reason is that H.I.V. is most common among young people, while the coronavirus has hit older people hardest.

An H.I.V. infection makes a person about 1.7 times as likely to die of Covid — an elevated risk, but one that pales in comparison with the risk for people with diabetes, who are 30 times more likely to die. “Once we realized that this was the situation, we then began to understand that our real problems with H.I.V. in the midst of Covid was the prospect that severely immunocompromised people would lead to new variants,” Dr. Abdool Karim said.

. . .

. . . a single variant can rattle the world, as Omicron has.

The origin of this variant is still unknown. People with H.I.V. are not the only ones whose systems can inadvertently give the coronavirus the chance to mutate: It can happen in anyone who is immunosuppressed, such as transplant patients and those undergoing cancer treatments.

By the time the KRISP team identified the second case of a person with H.I.V. producing coronavirus variants, there were more than a dozen reports of the same phenomenon in medical literature from other parts of the world.

Viruses mutate in people with healthy immune systems, too. The difference for people with H.I.V., or another immunosuppressing condition, is that because the virus stays in their systems so much longer, the natural selection process has more time to favor mutations that evade immunity. The typical replication period in a healthy person would be just a couple of weeks, instead of many months; fewer replications mean less opportunities for new mutations.

. . .

. . ., South Africa’s efforts to tackle the variant issue, and be transparent about it, have come at a steep price, in the form of flight bans and global isolation.

“As scientists, especially in the kind of forefront, we debate playing down the H.I.V. problem,” Dr. de Oliveira mused in his lab last week. “If we are very vocal, we also risk, again, big discrimination and closing borders and economic measures. But, if you are not very vocal, we have unnecessary deaths.”

For the full story, see:

Stephanie Nolen. “A Variant Hunt on Dirt Roads and in the Lab.” The New York Times, First Section (Sunday, December 5, 2021): 1 & 14.

(Note: ellipses added.)

(Note: the online version of the story was updated Dec. 6, 2021, and has the title “The Variant Hunters: Inside South Africa’s Effort to Stanch Dangerous Mutations.” The online version says that the New York edition of the print version had the title “A Variant Hunt From the Labs To Dirt Roads.” The title of my National edition of the print version was “A Variant Hunt on Dirt Roads and in the Lab.”)

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