Man with HIV endured 2-year Covid infection, study reveals new record

A Lancet study documents a 41-year-old's persistent Covid infection lasting more than 750 days, raising concerns about viral evolution in immunocompromised patients

A man in his forties living with advanced HIV carried an active Covid-19 infection for more than two years, setting a new record, documented a study in The Lancet. Scientists say his prolonged infection offers vital lessons for managing coronavirus in people with severely compromised immune systems.

 

The man first contracted Covid around May 2020. Unlike most patients who recover within weeks, his immune system was severely weakened to a point that the virus lingered inside his body for more than 750 days. Over this period, he was hospitalised five times, struggling with persistent breathing difficulties, headaches, body aches, and fatigue.

 

 

Researchers studying his case stress that this is not long Covid, where symptoms remain after the virus has cleared, but an active infection that continued replicating for over two years. His T-cell count, a key element of immune strength, had dropped to just 35 cells per microlitre of blood, far below the healthy range. Without effective HIV treatment at the time, his immune defences were unable to fight the virus off.

What the Lancet study revealed

 

A research paper titled 'Characterisation of a persistent SARS-CoV-2 infection lasting more than 750 days in a person living with HIV: a genomic analysis' was published in The Lancet Microbe journal. It traces his infection, with eight clinical specimens collected between March 2021 and July 2022.

Key findings include:

 

• The virus was from the early B.1 lineage, and all the samples showed it came from the same original infection, with no signs that he caught Covid again during those two years.
• Over the course of the infection, scientists found 68 consensus and 67 sub-consensus single nucleotide variants (SNVs). These are mutations that either became dominant in the viral population inside him (consensus) or were present in lesser proportions (sub-consensus).
• The rate at which the virus mutated inside him (intrahost clock rate) was very close to what was seen in viruses spreading in the general community. This suggests that the virus was evolving steadily, even within one individual.
• Crucially, 10 mutations were observed that matched those seen later in the Omicron lineage and were already present before November 2021.
• Despite this internal evolution, there was no indication that others had caught the virus from him.

 

“The convergent evolution shows how long-term infections allow the virus to explore ways to infect cells more efficiently, and adds to the evidence that more transmissible variants have emerged from such infections. Effectively treating such cases is hence a priority for both the health of the individual and the community,” said William P Hanage, PhD, associate professor of epidemiology at Harvard University and co-author of the study, in an interaction with Contagion.

Implications and warnings

 

The study suggests persistent infections in immunocompromised people can serve as internal laboratories for viral mutation. When the immune response is weak, the virus has more time to change. Some of those changes may mirror ones seen in virulent variants, like Omicron.

 

“It is notable that the patient in this case did not receive antivirals or other therapies directed at SARS-CoV-2, and their HIV-1 infection was poorly controlled with persistently low CD4 counts. This illustrates the importance of adequate access to healthcare for all, because we have treatments for both viruses which could have resolved this infection,” added Hanage.

 

The lack of detected transmission is reassuring, but it doesn’t eliminate risk. Researchers argue that earlier and more consistent treatment (both of HIV and SARS-CoV-2) is essential. If HIV is well managed, the immune system stands a better chance at clearing Covid-19.

 

“The vast majority of persistent infections do not produce highly transmissible variants, in large part because adaptation to successfully replicate in an individual patient is quite different from adapting to successfully transmit to a new host,” Hanage explained. “Even though evolution to produce more transmissible variants is rare, it remains a risk. And that risk can be reduced by treating such infections.”

What this means going forward

 

This case is extraordinary in its length and depth of analysis. It underlines the need for:

 

• Better healthcare access for people with HIV and other conditions that suppress immunity
• Early antiviral treatment when SARS-CoV-2 is detected in such individuals
• Vigilant genomic surveillance of persistent infections, so new variants can be caught early

 

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This report is for informational purposes only and is not a substitute for professional medical advice.