Association Between Human Immunodeficiency Virus Viremia and Compromised Neutralization of Severe Acute Respiratory Syndrome Coronavirus 2 Beta Variant 

People with HIV have weaker immune responses to vaccination and infection with other pathogens if their disease is not well-controlled with antiretroviral therapy (ART). We recruited people who were hospitalised with Covid from several hospitals in the Durban area. We measured antibodies targeting SARS-coronavirus-2 in blood plasma samples from people who had Covid during the Beta variant wave in early 2021, using three methods: binding to part of the coronavirus Spike protein, neutralisation of infectious (“live”) coronavirus, and a surrogate virus neutralisation test (sVNT) that simulates neutralisation without having to use infectious virus. A larger percentage of participants had detectable HIV in their blood (viremia) during the Beta wave than in the previous wave. The seven people who had HIV but whose viral loads were suppressed to undetectable levels had similar anti-coronavirus antibody levels to HIV-negative people, but HIV viremic participants had much lower antibodies. People with low CD4 T cells (the immune system cell that is directly infected by HIV) had a lower chance of developing anti-coronavirus IgG and IgA antibodies (IgG is the dominant antibody in blood, and IgA in the respiratory tract and mucous membranes). Neutralisation of Beta variant virus by plasma from HIV-negative participants, and participants who had HIV but undetectable viral loads, was much higher than from people with HIV viremia. The former two groups showed a decrease in the potency of neutralisation of the newer Delta variant, but it was still detectable. In contrast, plasma from most people with HIV viremia could not neutralise Delta at all. This shows the importance of improving ART access to protect people with HIV from Covid and other diseases.