s41467-022-35689-1.pdf (2.63 MB)
Effects of tuberculosis and/or HIV-1 infection on COVID-19 presentation and immune response in Africa.
journal contributionposted on 2023-01-13, 11:46 authored by Elsa du Bruyn, Cari Stek, Remi Daroowala, Qonita Said-Hartley, Marvin Hsiao, Georgia Schafer, Rene T Goliath, Fatima Abrahams, Amanda Jackson, Sean Wasserman, Brian W Allwood, Angharad G Davis, Rachel P-J Lai, Anna K Coussens, Katalin A Wilkinson, Jantina de Vries, Nicki Tiffin, Maddalena Cerrone, Ntobeko AB Ntusi, HIATUS consortium, Catherine Riou, Robert J Wilkinson
Few studies from Africa have described the clinical impact of co-infections on SARS-CoV-2 infection. Here, we investigate the presentation and outcome of SARS-CoV-2 infection in an African setting of high HIV-1 and tuberculosis prevalence by an observational case cohort of SARS-CoV-2 patients. A comparator group of non SARS-CoV-2 participants is included. The study includes 104 adults with SARS-CoV-2 infection of whom 29.8% are HIV-1 co-infected. Two or more co-morbidities are present in 57.7% of participants, including HIV-1 (30%) and active tuberculosis (14%). Amongst patients dually infected by tuberculosis and SARS-CoV-2, clinical features can be typical of either SARS-CoV-2 or tuberculosis: lymphopenia is exacerbated, and some markers of inflammation (D-dimer and ferritin) are further elevated (p < 0.05). Amongst HIV-1 co-infected participants those with low CD4 percentage strata exhibit reduced total, but not neutralising, anti-SARS-CoV-2 antibodies. SARS-CoV-2 specific CD8 T cell responses are present in 35.8% participants overall but undetectable in combined HIV-1 and tuberculosis. Death occurred in 30/104 (29%) of all COVID-19 patients and in 6/15 (40%) of patients with coincident SARS-CoV-2 and tuberculosis. This shows that in a high incidence setting, tuberculosis is a common co-morbidity in patients admitted to hospital with COVID-19. The immune response to SARS-CoV-2 is adversely affected by co-existent HIV-1 and tuberculosis.