As South Africa has entered a fourth wave that is advancing at a rapid pace ” never seen “ According to the authorities, HIV-positive patients are canceling their follow-up consultations again, as they have already done with each wave since the start of the Covid-19 pandemic. “In the clinics we work with, the number of people diagnosed with HIV has been cut in half. The number of patients under treatment has also decreased and the number of people who do not come to consultations is increasing ”, explains Dr Moyahabo Mabitsi, executive director of the South African organization Anova, which supports the government in HIV testing and treatment in more than 500 clinics.
With nearly eight million people living with HIV, South Africa is the primary focus of the HIV epidemic in the world. While nearly five million of them are effectively monitored and have an undetectable viral load, at least two million are not on treatment and it is feared that the figure is underestimated.
In a column published on December 2 in the journal Nature, four South African scientists, including two members of the team behind the discovery of the Beta and Omicron variants, challenge the international community on the risk that this break in access could pose to the evolution of the pandemic in the care of people living with HIV: “Failure to fight the pandemic at the height of the emergency in countries with high rates of people infected with advanced HIV and insufficiently treated could lead to the emergence of variants of the coronavirus SARS-CoV-2 more transmissible or making less effective vaccines. “
The hypothesis of prolonged infection in immunocompromised
A carefully balanced statement to communicate on one of the most sensitive hypotheses on the sudden emergence of highly mutated variants. Prolonged SARS-CoV-2 infection in people immunocompromised both from cancer chemotherapy treatment and HIV infection could be involved in the emergence of the Alpha variant, discovered in the UK in November 2020, from the Beta variant, discovered in South Africa in October 2020, from the Gamma variant, discovered in Manaus, Brazil, in January, and now, from the Omicron variant.
Co-signer of this forum, Professor Koleka Mlisana, Executive Director of the National Health Laboratory Service, the South African public medical analysis network, specifies at the outset that “HIV-positive people who follow an effective treatment and do not present a detectable viral load react to Covid-19 like the others”. Things seem more complex in immunocompromised patients, due to a poorly controlled viral load due to lack of adequate access to antiretroviral therapy.
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