Could HIV and COVID Collide, Complicating Efforts to Eradicate the Pandemic?

by Kilian Melloy

EDGE Staff Reporter

Saturday June 5, 2021

HIV and COVID may be colliding to create an even more complicated roadmap to eradicating the virus due to genetic shifts that could change the behavior of SARS-CoV-2, the Los Angeles Times reports.

As EDGE previously noted, HIV is "an epidemic whose infections and fatalities are ominously mirrored by today's global health emergency [of COVID-19], though the response and action around each have differed."

But new research indicates that the epidemics don't simply mirror one another; untreated cases of HIV, as well as other maladies that compromise the human immune system, may actually be making the COVID-19 crisis worse because immuno-compromised COVID patients are unable to fight off the coronavirus as quickly as others. That means that COVID-19 viral particles have more time to replicate in the cells of infected people, and in the process of replication new genetic variants can arise.

A case in point is a 36-year-old COVID-19 patient in South Africa who is was also HIV-positive, the LA Times said. The woman was not receiving any medication for HIV. She remained ill with COVID for eight months, though she never became "severely ill," the article said.

Despite her comparatively mild symptoms, "the coronavirus that lingered in her body underwent 13 genetic changes related to its crucial spike protein, along with at least 19 other genetic shifts elsewhere that could change the behavior of the virus," the article noted.

The findings are a new point of contact between the two epidemics, for which LGBTQ advocates have found no lack of contrasts and parallels. For the first time, researchers could see that untreated HIV could help facilitate the mutation of the COVID virus.

That's a worrisome combination, given both the number of people living with untreated HIV worldwide and the fact that poorer nations - unlike their richer counterparts - cannot easily afford campaigns of mass vaccination to help drive COVID-19 numbers down. Similar disparities exist with respect to HIV; the LA Times pointed out that "Worldwide, roughly 8 million people are thought to be infected with HIV but unaware of their status. An additional 1.7 million are on antiretroviral medications that aren't working well."

The confluence of the two epidemics prompted one expert, Dr. Jonathan Li of Brigham and Women's hospital in Boston, to call the situation a "syndemic" - "a term that describes the confluence of two epidemics with the potential to worsen outcomes for both," the LA Times explained.

Dr. Li had predicted that just such an interaction between the two epidemics might be possible when he documented "the proliferation of significant coronavirus mutations in a single immunocompromised patient," the Times article said.

The new development is a new wrinkle in the legacy of early apathy on the part of governments - including that of the United States - in addressing the HIV epidemic.

Vincent Crisostomo (he/him), director of aging services at the San Francisco AIDS Foundation, pointed out ties and parallels between the two epidemics, telling EDGE, "Just like the AIDS crisis, only time will tell us how many people might have survived COVID-19 had the previous White House administration responded appropriately at the beginning stages of the pandemic."

There is, however, the possibility of a silver lining: The response to the COVID-19 pandemic, albeit somewhat belated, could conceivably lead to an effective vaccine against HIV — a potential upside that Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, mentioned in comments he recently made to Today.

Referencing the speed with which not just one, but several, vaccines were developed to combat COVID-19, Fauci said, "Hopefully some of the things we've learned from the COVID-19 vaccines will ultimately help us to develop a successful and highly effective HIV vaccine."

"While HIV attacks the body differently than COVID-19, the process of developing vaccines for COVID-19 has taught specialists ways to reimagine vaccine development," Insider noted.

Like HIV before it, COVID-19 seems poised to become part of the health landscape — largely manageable through medical intervention, but still causing illness and even death, per an article published last month by the New York Times.

The idea of achieving "herd immunity" — once proposed as a means of defeating COVID and managing a return to normalcy — now seems less likely, the Times noted, because although an effective vaccination program under U.S. President Joe Biden's administration has led to more than half of the nation's adult population to being vaccinated with at least one dose, "daily vaccination rates are slipping, and there is widespread consensus among scientists and public health experts that the herd immunity threshold is not attainable — at least not in the foreseeable future, and perhaps not ever."

"Herd immunity" is the point at which a population gains less overall vulnerability to an illness through resistance to that illness (either by having become sick and then recovered, thus gaining resistance naturally or through vaccination). The previous administration held herd immunity as an inevitable outcome that would bring the COVID crisis to a natural conclusion. For some, the idea of herd immunity replaced the strategy of an aggressive program of vaccinations. Yet, Dr. Fauci told the Times, "People were getting confused and thinking you're never going to get the infections down until you reach this mystical level of herd immunity, whatever that number is."

A better message, Fauci says, is: "Forget that for a second. You vaccinate enough people, the infections are going to go down."

Similarly, a well-coordinated program of vaccination and prevention against HIV could help in the fight against COVID while, at the same time, finally end the four-decade AIDS epidemic. But, Dr. Fauci noted, more research is needed before an effective HIV vaccine can be developed.

"We have highly effective vaccines against COVID-19 because we know the body can do it, and we induce the body to do it," Fauci told Today. "With HIV, that's not the case. We've got to do better than what natural infection does."
