The Beta COVID variant in patients with advanced HIV can create conditions that can lead to the evolution of dangerous mutations in SARS-CoV-2, researchers have warned.

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A team from the Africa Health Research Institute in South Africa revealed the case study is of a patient with advanced HIV who, despite having only mild COVID-19 illness, tested SARS-CoV-2 positive for 216 days. Genomic sequencing revealed shifts in the patient's SARS-CoV-2 viral population over time, involving multiple mutations at key sites including the spike protein domain which SARS-CoV-2 uses to enter human cells. The evolved virus was tested and shown to have variant-like properties in terms of its ability to escape antibodies.

"Evolved mutations lead to escape from neutralisation, which means antibodies made as a result of previous natural infection or vaccination would work less well to protect you from a new infection," said Alex Sigal, from the Institute. "SARS-CoV-2 may mutate extensively within one person if infection persists," he added. The Beta COVID variant (also known as B1351), first identified in South Africa, is leading to more severe disease in people living with HIV. Control of HIV with antiretroviral therapy could be the key to preventing such evolution of SARS-CoV-2 in patients with advanced HIV, since clearance of the virus is compromised if HIV is allowed to replicate for a long time and results in major damage to the immune system, the researchers explained.

"Such findings underline the need to make sure everyone living with HIV has appropriate treatment. If not, it is possible that potentially more potent variants than the ones circulating now could emerge from people whose immune systems are severely damaged," Sigal said. The team will present the case study at the 2021 European Congress of Clinical Microbiology and Infectious Diseases to be held online between July 9 and 12.