Immunological Profiles of HIV-infected and Uninfected Patients Admitted with COVID-19 in Tshwane

People living with HIV (PLHIV) could have worse COVID-19 outcomes due to persistent immune deficiency and dysregulation. This study determined and compared the immunological profiles and clinical outcomes of PLHIV and HIV-uninfected patients admitted with COVID-19 to hospitals in Tshwane, South Africa. One hundred and thirty SARS-CoV-2 PCR-positive patients with moderate to severe COVID-19 were recruited from April 2020 to July 2021. Whole blood samples were obtained during the first day of hospitalization and T-cell and monocyte phenotyping performed on a CytoFlex flow cytometer. Data were analyzed using FlowJo v10.7.1 and the Cytobank platform. Twenty-six patients were PLHIV: median CD4 count 212 cells/mm³; suppressed HIV viral load in 61%. PLHIV were younger (45.5 ±10.81versus 53 ±13.34 years), more likely to be female (73.08% versus 40.38%) and had less severe disease (ROX score 16.2 [IQR 8.8- 22.62] versus 7.92 [IQR 4.35-14.12]) than HIV-uninfected patients. Mortality was similar between the groups: 15.38% versus 7.69% in PLHIV (p=0.838). PLHIV had lower CD4+ (p=0.0001) and higher CD8+ (p=0.0001) T-cell counts, higher CD8+ naïve (p=0.049) and lower CD8+ effector (p=0.021) and exhausted T-cells (p=0.0079), and lower CCR2 expression on monocytes (p=0.0065). After adjusting for ROX, PLHIV had fewer CD4+ effector T-cells (p=0.0006). Differences in CD8+ T-cells remained together with lower CD8+ effector memory-1 (p=0.028), PE2 (p=0.028) and TEMRA (p=0.0098), higher effector memory-2 (p=0.0042) subsets, higher proportions of non-classical monocytes (p=0.0041) and lower CCR2 expression (p=0.0058) in PLHIV. We suggest that skewed CD8+ T-cell maturation could be protective against development of hyper-inflammation during COVID-19 in PLHIV.