Abstract:
Whether SARS-CoV-2 infection leads to a higher mortality and morbidity in people living
with HIV (PLWH) in Africa remains inconclusive. In this study, we explored the differences in the
T-cell phenotypes between people with and without HIV on the day of admission (V1) and ±7 days
later (V2), as well as their cytokine/chemokine profiles on V1. Patients admitted with COVID-19
were recruited between May 2020 and December 2021 from the Steve Biko Academic and Tshwane
District Hospitals in Pretoria, South Africa. Of 174 patients, 37 (21%) were PLWH. T-cell profiles were
determined by flow cytometry, and cytokine levels were determined using a multiplex suspension
bead array. PLWH were significantly younger than those without HIV, and were more likely to
be female. In an adjusted analysis, PLWH had higher percentages of CD4+ central memory (CM)
programmed cell death protein 1 (PD-1)+, CD8+ effector memory (EM)2, and CD8+ EM4 CD57+ cells,
as well as higher concentrations of interleukin (IL)-35 at admission. PLWH with CD4+ T-cell counts
of >200 cells/mm3 had altered CD4+ and CD8+ T-cell profiles, lower levels of systemic inflammation
measured by plasma ferritin and PCT levels, and less severe disease. PLWH with CD4+ T-cell counts
of <200 cells/mm3 on admission had higher concentrations of IL-6 and lower levels of IL-29. At V2,
the percentages of CD4+ CM PD-1+ T-cells and CD8+ EM4 T-cells co-expressing CD57 and PD-1
remained higher in PLWH, while all other CD8+ EM populations were lower. Fewer CD8+ EM
T-cells after ±7 days of admission may be indicative of mechanisms inhibiting EM T-cell survival,
as indicated by the higher expression of IL-35 and the T-cell maturation arrest observed in PLWH.
This profile was not observed in PLWH with severe immunodeficiency, highlighting the need for
differentiated care in the broader PLWH population.
