Accumulating SARS-CoV-2 mutations in prolonged COVID-19 in advanced HIV off-ART

Kirk Taylor, HIV i-Base

This paper includes a case report that tracks the accumulation of more than 20 key mutations in an HIV positive person with prolonged COVID-19.

Once started, ART suppressed HIV and SARS-CoV-2 cleared within nine weeks.

The 22-year-old South African has been HIV positive since birth. At time of presentation her HIV was not well managed with viral load >100,000 copies/mL and CD4 count of 91 cells/mm3. Restarting ART reduced viral load but 8 months later, viremia remained high and COVID-19 illness persisted. Switching to a TLD regimen reduced viral load to ≥50 copies/mL and COVID-19 cleared within 6 to 9 weeks.

Ref: Maponga TG et al. Persistent SARS-CoV-2 infection with accumulation of mutations in a patient with poorly controlled HIV infection. Clinical Infectious Diseases, ciac548, doi: 10.1093/cid/ciac548 (06 July 2022).

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