The pandemic may be heading in an ominous direction as COVID-19 collides with HIV / AIDS


File-In this July 2, 2020 file photo, nurse Nomautanda Siduna speaks to an HIV-positive patient in Gazebo, which is being used as a mobile clinic in Godwana, South Africa. Researchers found that shots of laboratory drugs every two months were more effective than daily torubada pills to prevent uninfected women from getting HIV from infected sex partners. Research is discontinued early. The news is good news, especially for AIDS prevention efforts in Africa. In Africa, this study has been conducted and there are few prudent ways for women to protect themselves from infection. (AP Photo / Bram Janssen, file)

A nurse talking to an HIV-positive patient in Godwana, South Africa. Scientists say the clash between COVID-19 and HIV / AIDS could exacerbate the pandemic. (Bram Janssen / Associated Press)

South African researchers have just recorded an ominous development, a pandemic-HIV / AIDS clash, as less wealthy countries in the world rush to fight for the COVID-19 vaccine and fight the proliferation of deadly diseases. is.

Geneticists and infectious disease experts have discovered a potentially dangerous coronavirus mutation in a 36-year-old woman who has been unable to wield the SARS-CoV-2 virus for nearly eight months and has no control over HIV. did. The driving force behind the rapid accumulation of genetic changes in the patient is probably a decline in her immune response due to the failure of her HIV treatment, the researchers said.

This case highlights a difficult truth. Wealthy countries are competing to vaccinate their populations, but remain vulnerable and vaccinated as long as the coronavirus is widespread and mutated in low- and middle-income countries. This keeps COVID-19 immunization rates low. This is especially true in countries like South Africa, where HIV infection is common but often undetectable.

“This highlights the benefits of this virus until we brake, and we need to brake globally,” he said. Dr. Bruce Walker, Founding Director of the Ragon Institute, Boston’s Immunology Research Center.

A South African patient was diagnosed with HIV in 2006, but doctors were unable to control viral load with standard antiretroviral therapy, and her immune system count of CD4 + T cells (playing a role in eliminating coronavirus infection). There were very few). ..

For 216 days, women continued to test positive for the SARS-CoV-2 virus. She was hospitalized for nine days with a moderate illness in September shortly after being infected with the coronavirus, but was not severely ill with COVID-19.

Nonetheless, the coronavirus that remained in her body underwent 13 genetic alterations associated with its important peplomer and at least 19 other genetic shifts elsewhere that could alter the behavior of the virus.

A new discovery is an effort to eradicate the COVID-19 pandemic, where HIV / AIDS (a tragedy that occurred 40 years ago and killed 32 million people worldwide) killed more than 3.5 million people in less than a year and a half. It causes anxiety that it can be complicated.

Until the advent of South African patients, there was little evidence that HIV-infected individuals could complicate the pandemic trajectory. It is not known that people living with HIV are more likely to be infected with the coronavirus.And research suggested them Did not suffer from worse medical results Of COVID-19.

But if her case turns out to be typical, the situation can change. Trio de Oliveira, A geneticist at the University of KwaZul Natal in Durban, led a new study.

Patient inhales oxygen in COVID-19 ward

Patients are inhaling oxygen in the COVID-19 ward of Khayelitsha Hospital, about 20 miles from the center of Cape Town. (Roger Bosch / Getty Images)

World wide, About 8 million people I am believed to be infected with HIV, but I am not aware of the condition. An additional 1.7 million people are taking ineffective antiretroviral drugs.

The prospect that uncontrolled HIV in nearly 10 million patients could produce new variants of the coronavirus has broad implications.

“This is a syndemic.” Dr. Jonathan Lee, Use terminology to describe the confluence of two epidemics that can exacerbate both outcomes.

Lee, an infectious disease specialist at Brigham and Women’s Hospital in Boston, was one of the first to record an infectious disease epidemic. Significant coronavirus mutations in single immunodeficient patients A person who succumbed to COVID-19 last summer after being unable to cure a coronavirus infection for more than 5 months. His case reminded doctors that such patients could be powerful incubators of viral variants.

Lee’s biggest patient is an HIV-infected person. He has been a source of mutations that can increase the transmission of the virus and make it difficult to prevent and treat HIV-infected individuals since the emergence of potentially dangerous coronavirus variants. He said he “crossed his fingers” so that he wouldn’t.

“This is one of the first reports that some of my concerns may come true,” said Li, who was not involved in the new study.

A South African patient was infected with the coronavirus in September. The country’s second surgeAlthough she was infected with the strain that prevailed in the country’s first wave of infection.

Over the next 27 weeks, more than 30 genetic alterations were detected in the patient’s virus sample. This includes a few changes that have been shown to enhance the ability of the virus to resist vaccines and drugs that prevent or treat COVID-19.

If they became widespread, it could have become a public health nightmare called an “escape variant” that could prolong the pandemic.

It is not yet clear if any of the mutations she had have spread to others. However, researchers said it was probably not a coincidence that a dangerous new variant emerged from a population such as KwaZulu-Natal, South Africa, where more than one in four adults is infected with HIV. ..

The patient was the subject of a briefing to the African Public Health Minister’s organization last month, details of which will soon be shared with World Health Organization leaders. A case report was posted on the website Thursday for researchers to seek feedback on their research before it was officially published.

It is too early to know if the woman is abnormal. However, the report of her case was widely expected by other scientists who wanted to scrutinize it.

A person undergoing a COVID-19 test in a tent

Residents of Alexandra Township will be tested for COVID-19 in Johannesburg, South Africa. (Jerome Delay / Associated Press)

Surprisingly, the mutation that appeared in a South African patient did not appear to be a direct response to a powerful drug aimed at treating COVID-19. The main treatment she received in the hospital was It was oxygen supplementation.

In fact, if she hadn’t been enrolled in a study of COVID-19 patients with HIV or tuberculosis, she probably didn’t realize she could have spread the newly hatched viral variant to others. Probably. Perhaps her proceedings would not have been scrutinized any further.

Instead, she became one of the 300 participants whose COVID-19 seizures were studied to better understand how HIV affects the progression of coronavirus infection and the immune response. I did. Her blood was tested for SARS-CoV-2 the day she participated in the study and seven times thereafter.

Approximately six months after the study, two drugs in her antiretroviral HIV cocktail were replaced. Within two weeks, her HIV was tightly controlled and her SARS-CoV-2 infection was resolved.

The other four who participated in the study had a coronavirus infection that lasted more than a month. Researchers will also look for mutants in the samples.

New discoveries increase the risk of diagnosing and treating people everywhere with unrecognized or poorly treated HIV, says research leader De Oliveira. ..

Expanded testing and treatment for undetected HIV-infected individuals has the potential to reduce HIV mortality, reduce HIV transmission, and generate new variants of COVID that can cause waves of other infections. Will also reduce. “

Countries with low vaccination and high levels of infection appear to provide fertile soil for new strains, as shown by the beta variant in South Africa and the gamma variant in Brazil. These variants can create a new wave of reinfection in their hometown and far away, even in countries with high vaccination levels.

In South Africa, where there are nearly 2.2 million untreated HIV-infected people Vaccinated With only 183,000 as of May 31, health officials are afraid of a new wave of infection.

India, which is currently experiencing the world’s worst COVID-19 surge, has nearly one million untreated HIV-infected persons. Only 12% of Indians are initially vaccinated with the COVID-19 vaccine and 3.2% are fully vaccinated.

For comparison, the United States provided initial vaccinations to 51% of the population and 41% were fully vaccinated.

“We need to be committed to making the vaccine available worldwide,” said Walker of the Ragon Institute. “And we have to deal specifically in areas where the infection is most rapid.”

Women get vaccinated

Healthcare worker Maggie Sedidi receives Johnson & Johnson’s COVID-19 vaccine in Soweto, South Africa. (Temba Hadebe / Associated Press)

The female case may also help explain why more than half of the new coronavirus variants detected so far were first recorded in Africa.

The continent is home to an estimated 7.5 million HIV-positive people who have not been effectively treated with antiretroviral therapy. In most cases, the immune system is weakened and the virus replicates and mutates for a longer period of time.

However, the prospect that untreated HIV could complicate the end of the COVID-19 pandemic suggests a synergistic way to address both problems in parallel, De Oliveira said. T.

“This could be a great opportunity to control the HIV epidemic and protect the world from variants,” he said.

This story was originally Los Angeles Times..

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