COVID‐19 in people living with HIV: clinical implications of dynamics of immune response to SARS‐CoV‐2

Mondi, A.; Cimini, E.; Colavita, F.; Cicalini, S.; Pinnetti, C.; Matusali, G.; Casetti, R.; Maeurer, M.; Vergori, A.; Mazzotta, V.; Gagliardini, R.; De Zottis, F.; Schininà , V.; Girardi, E.; Puro, V.; Ippolito, G; Vaia, F.; Capobianchi, M.R.; Castilletti, C.; Agrati, C.; Antinori, A.

BACKGROUND: Little evidence on COVID‐19 in people living with HIV (PLWH) is currently available. MATERIAL AND METHODS: We reported clinical and viro‐immunological data of all HIV‐positive patients admitted to our centre with COVID‐19 from March 1 to May 12(,)2020. RESULTS: Overall, five patients were included: all were virologically‐suppressed on antiretroviral therapy and CD4+ count was >350 cell/mm(3) in all but two patients. Although all patients had evidence of pneumonia on admission, only one developed respiratory failure. SARS‐CoV‐2‐RNA was never detected from nasopharyngeal swabs in two patients, whereas, in the others, viral clearance occurred within a maximum of 43 days. IgG production was elicited in all patients and neutralizing antibodies in all but one patient. Specific‐T‐cell response developed in all patients but was stronger in those with more severe presentation. Similarly, the highest level of pro‐inflammatory cytokines was found in the only patient experiencing respiratory failure. Despite a mild presentation, patients with more pronounced immunosuppression showed high degrees of both cytokines production and immune‐activation. CONCLUSIONS: Our study did not find an increased risk and severity of COVID‐19 in PLWH. Adaptative cellular immune response to SARS‐CoV‐2 appeared to correlate to disease severity. The mild clinical picture showed in advanced HIV patients, despite a significant T‐cell activation and inflammatory profile, suggests a potential role of HIV‐driven immunological dysregulation in avoiding immune‐pathogenetic processes. However, other possible explanations, as a protective role of certain antiretroviral drugs, should be considered. Further larger studies are needed to better clarify the impact of HIV infection on COVID‐19. This article is protected by copyright. All rights reserved.