South African scientists — lauded for the discovery of the omicron — are investigating the “highly plausible hypothesis” that the emergence of new variants of Covid-19 could be related, in some cases, to mutations that occur within infected people whose immune system is already it has been weakened by other illnesses such as untreated HIV.
Researchers have already noted that Covid-19 can last for many months in HIV-positive patients, and that, for a variety of reasons, they do not take the drugs that would allow them to lead healthy lives.
“Normally, your immune system would kick out a virus quickly, if fully functional,” says Professor Linda-Gayle Bekker, who directs the Desmond Tutu HIV Foundation in Cape Town.
“In someone with suppressed immunity, we see the virus persisting. And it doesn’t sit still, it replicates. And as it replicates, it mutates potentially. And in someone who is immunosuppressed, this virus might be able to go on for many months — suffering mutation,” she adds.
But as they move forward with their research, scientists are eager to avoid further stigmatizing people living with HIV, both in South Africa — home to the world’s biggest HIV epidemic — and globally.
“It’s important to emphasize that people who are taking antiretroviral drugs have their immunity restored,” says Bekker.
Two cases of particular interest have already been detected in South African hospitals. One woman continued to be diagnosed positive for Covid-19 for nearly eight months earlier this year while the virus underwent more than 30 genetic changes.
The Brazilian Túlio de Oliveira, who heads the team that confirmed the discovery of the omicron, points out that “10 to 15” similar cases have been found in other parts of the world, including the United Kingdom.
“It’s a very rare event. But it’s a plausible explanation that immunosuppressed individuals can basically be a source of virus evolution,” he says.
South African scientists have faced criticism — and even death threats on social media — after their recent discovery of the omicron variant sparked controversial and economically damaging fast travel bans in Western countries.
They don’t want their country, or continent, to be seen as some kind of breeding ground for new variants.
The link between immunosuppressed patients and new covid variants is “a highly plausible hypothesis,” says Professor Salim Karim, a leading HIV expert and former chairman of the South African government’s Covid-19 advisory committee.
“But it’s not proven. We’ve seen five variants come from four different continents. So turning Africa into a scapegoat is just outrageous.”
Scientists also note that there are many other reasons, globally, why people’s immune systems may be compromised.
The emergence, for example, of the alpha variant has been associated with a patient receiving cancer treatment in the UK.
“Diabetes, cancer, hunger, autoimmune diseases, chronic tuberculosis, obesity — we have a huge population of people with suppressed immunity for other reasons,” says Professor Marc Mendelson, head of infectious diseases at Cape Town’s Groote Schuur Hospital.
In South Africa, nearly 8 million people are living with HIV, the virus that causes AIDS. But about a third of them are not taking medication.
In Masiphumelele, a populous municipality squeezed between rocky slopes and the Atlantic Ocean, south of Cape Town, an estimated one-quarter of the municipality’s adult population has HIV.
“There are many problems. [pessoas] don’t want to take the test. Some don’t want to know. There is a stigma surrounding HIV,” says community worker Asiphe Ntshongontshi, explaining why, despite the presence of an extremely effective health program, a significant number of people are not taking prescribed medications.
Currently, there is no evidence that any of the Covid-19 concern variants have emerged in Africa, although the sudden arrival of a variant as transmissible as omicron in southern Africa has fueled speculation that it may be linked to someone with a compromised immune system.
Scientists tracking the virus say they hope this concern about a possible link to HIV will spur greater global action at a time when the fight against HIV has been neglected, in some areas, by the pandemic.
“It’s a global problem — this need to understand how viral infections thrive in our global community. And the best resource we have (to address it) right now is vaccination. That message needs to be said out loud.” says Bekker.
Although Africa still lags far behind the rest of the world in covid vaccinations, South African researchers say it is important to pay special attention to people with weakened immune systems, who may need four or even five booster shots for the vaccines. trigger an adequate immune response.
“If we want to reduce the risk of new variants, we have to face this challenge in every country in the world. This is trying to ensure that immunocompromised individuals are fully vaccinated and have detectable immune responses to the vaccines”, he explains.
“And if not, they must receive extra doses until they develop an immune response. This is our best protection against the possibility that people with compromised immune systems are developing variants,” concludes Karim.
In Brazil, the Ministry of Health has just announced the application of the fourth dose for immunosuppressed patients.
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