Emergence of neutralizing antibodies associates with clearance of SARS-CoV-2 during HIV-mediated immunosuppression

Authors:

Farina Karim^1,2, Catherine Riou^3,4, Mallory Bernstein¹, Zesuliwe Jule¹, Gila Lustig⁵, Strauss van Graan^6,7, Roanne S. Keeton³, Janine-Lee Upton¹, Yashica Ganga¹, Khadija Khan^1,2, Kajal Reedoy¹, Matilda Mazibuko¹, Katya Govender¹, Kershnee Thambu¹, Nokuthula Ngcobo¹, Elizabeth Venter^6,7, Zanele Makhado^6,7, Willem Hanekom^1,8 , Anne von Gottberg^9,10, Monjurul Hoque¹¹, Quarraisha Abdool Karim^5,12, Salim S. Abdool Karim^5,12, Nithendra Manickchund¹³, Nombulelo Magula¹⁴, Bernadett I. Gosnell¹³, Richard J. Lessells^5,15, Penny L. Moore^6,7, Wendy A. Burgers^3,4, Tulio de Oliveira^5,15,16,17, Mahomed-Yunus S. Moosa¹³, Alex Sigal^1,2,5

Abstract

The emergence of new variants through SARS-CoV-2 evolution compromises the effectiveness of current vaccines. Persistent SARS-CoV-2 infection because of immunosuppression may drive accelerated SARS-CoV-2 evolution and it is therefore critical to understand how such persistent infections can be cleared. While adaptive immunity is known to be required for SARS-CoV-2 clearance, the relative contribution of neutralizing antibodies and T cells to clearance in immunosuppression is not well understood. Here we examined whether neutralizing antibody and T-cell responses are associated with the clearance of persistent SARS-CoV-2 infection in people recovering from advanced HIV-mediated immunosuppression through adherence to HIV antiretroviral therapy.

This study demonstrated that neutralizing antibodies may be required for SARS-CoV-2 clearance in recovery from HIV-mediated immunosuppression. Successful management of HIV is necessary to curtail the evolution of co-infecting pathogens.

Affiliations

¹Africa Health Research Institute, Durban, South Africa.
²School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.
³Institute of Infectious Disease and Molecular Medicine, Division of Medical Virology, Department of Pathology, University of Cape Town, Observatory, South Africa.
⁴Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Observatory, South Africa.
⁵Centre for the AIDS Programme of Research in South Africa, Durban, South Africa.
⁶SAMRC Antibody Immunity Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁷National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.
⁸Division of Infection and Immunity, University College London, London, UK.
⁹Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa.
¹⁰School of Pathology, University of the Witwatersrand, Johannesburg, South Africa.
¹¹KwaDabeka Community Health Centre, KwaDabeka, South Africa.
¹²Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.
¹³Department of Infectious Diseases, Nelson R. Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.
¹⁴Department of Internal Medicine, Nelson R. Mandela School of Medicine, University of Kwa-Zulu Natal, Durban, South Africa.
¹⁵KwaZulu-Natal Research Innovation and Sequencing Platform, Durban, South Africa.
¹⁶Centre for Epidemic Response and Innovation, School of Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa.
¹⁷Department of Global Health, University of Washington, Seattle, USA.