[Q&A] COVID-19, HIV and antiretroviral treatments

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While there is a considerable amount of general information out there about the spread of COVID-19, very little is targeted at people who may be immunosuppressed, including people living with HIV. We speak to Dr Tommy Tong, Immunologist and Senior Lecturer at the Department of Biological Science, Sunway University to learn about the risks of infection and use of HIV antiretroviral drugs to treat COVID-19.


Are people living with HIV at increased risk of being infected with COVID-19?

“At present, there is no evidence to suggest that there is an increased risk of COVID-19 infection for people living with HIV and on effective antiretroviral treatment (ART). The advice for people living with HIV is the same as everyone else. This include washing hands frequently, use alcohol-based hand sanitiser, avoid touching face and avoid people who are feeling unwell.”

What are the similarities found in HIV and SARS-COV2? 

“The published paper with the title “Uncanny similarity of unique inserts in the 2019-nCoV spike protein to HIV-1 gp120 and Gag” may have sparked this controversial, has been retracted because the scientific community has raised questions on the technical approach and data interpretation.

There is no evidence to suggest that there are similarities between HIV and SARS-COV2. A recently published report in early April 2020 (Zhang et al, Current Biology, 2020) revealed Pangolin-CoV genome to be about 91% identical to SARS-CoV2, and the BatCoV RaTG13 from Yunan shared a 96% whole-genome identity to SAR-CoV (Zhou et al, Nature, 2020). Hence, there is a possibility that this virus may have originated from an animal, as seen in other SARS virus (camels for MERS, civets for SARS).”

Does the new coronavirus attack the immune system like HIV? 

“Current evidence does not suggest this.”

Why are HIV drugs used to treat COVID-19? 

“At this stage, we should be asking a more pragmatic question ‘Are there existing, approved anti-viral drugs that can be used to treat COVID-19 infection and save lives?’ The repurposing of currently available drugs can buy us time while waiting for COVID-19-specific antiviral drug and vaccine. Currently, COVID-19 patients are treated with drugs ranging from Ivermectin, hydroxychloroquine, remdesivir and lopinavir/ritonavir.

The protease inhibitors lopinavir and ritonavir combination is usually administered as Highly Active Anti-Retroviral Therapy (HAART) to treat HIV. Back in 2004, this drug combination was shown to be effective against SARS in laboratory settings as well as improve the outcome of severe patients with SARS or MERS infection. Given that COVID-19 is similar to these two viruses, this treatment may have a beneficial effect on COVID-19 infected patients. Hydroxychloroquine, an antimalarial drug and lupus treatment was also shown to inhibit COVID-19 infection in China, South Korea and Malaysia. “

Some critically ill patients are said to have experienced cytokine storms, where the immune system overreacts and attacks healthy cells. Why and how does this happen? 

“A rapid and well-coordinated immune response is an important line of defence against viral infection. However, excessive immune responses may cause immune damage to the human body, a phenomenon known as cytokine storms. Cytokine storm is observed among critical patients infected COVID-19 with elevated levels of Interleukin-6 (IL-6). IL-6 is a cytokine that has a multifunctional role in the human immune system. An unregulated or over stimulation of IL-6 can lead to uncontrolled immune-mediated inflammatory response in the lower airways.”

Vaccines have traditionally taken two to five years to develop. However, for COVID-19, we are expecting to have a coronavirus vaccine in 12-18 months, which means we may have to rely on untested techniques. What are the implications and risks? 

“Untested techniques may have the potential to save lives. IL-6 levels are significantly elevated in severe COVID-19 infection, suggesting its crucial role in cytokine storm. IL-6 level also correlated with COVID-19 viral load. Therefore, blocking IL-6 receptor might be a promising strategy in disease management. Preliminary data using tocilizumab (an antibody against IL-6 receptor protein) together with routine therapy showed that it is effective in alleviating symptoms of COVID-19 infection. 

Ivermectin is a medication used to treat parasitic infestation has shown promising result in a laboratory setting, by reducing the virus ability to replicate in a dish, but this needs to be translated from the laboratory to clinical cases and studies.” 

Bionotes of expert

Dr Tommy Tong graduated from Monash University, Australia with PhD in Immunology. He was working on vaccine development against human immunodeficiency virus (HIV) for his PhD dissertation, before joining Professor James Binley at San Diego for Biomedical Research (SDBRI) in USA to continue his passion in HIV research for 4 years. He is now a lecturer at the Department of Biological Science, Sunway University, and has started his own laboratory to work on HIV vaccine for Malaysians. 

More information about HIV and COVID-19 here: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/hiv.html

** All previous posts about COVID-19 here: https://sciencemediacentremalaysia.com/tag/covid-19/

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