Exhausting T Cells During HIV Infection May Improve the Prognosis of Patients with COVID-19.

Huasong Lin ,Jing Wu,Ning Wang,Han-Sheng Xie,Chuan-Juan Chen,Ya-Lan Lin,Ying Fu,Jie Xiang,Danning Wen ,Ningfang Lian ,Yanqing Fan ,Shouhong Lin ,Fangzhan Peng ,Huadong Li ,Xu Sun ,Yi‐Han Lin ,Chaowei Li ,Chaolin Huang ,Qunfang Xie ,Wan‐Jin Chen ,Jianwen Wang ,Xiaohong Lin ,Jianqing Lin ,Yunfeng Chen

doi:10.3389/fcimb.2021.564938

Abstract

T-cell reduction is an important characteristic of coronavirus disease 2019 (COVID-19), and its immunopathology is a subject of debate. It may be due to the direct effect of the virus on T-cell exhaustion or indirectly due to T cells redistributing to the lungs. HIV/AIDS naturally served as a T-cell exhaustion disease model for recognizing how the immune system works in the course of COVID-19. In this study, we collected the clinical charts, T-lymphocyte analysis, and chest CT of HIV patients with laboratory-confirmed COVID-19 infection who were admitted to Jin Yin-tan Hospital (Wuhan, China). The median age of the 21 patients was 47 years [interquartile range (IQR) = 40–50 years] and the median CD4 T-cell count was 183 cells/μl (IQR = 96–289 cells/μl). Eleven HIV patients were in the non-AIDS stage and 10 were in the AIDS stage. Nine patients received antiretroviral treatment (ART) and 12 patients did not receive any treatment. Compared to the reported mortality rate (nearly 4%–10%) and severity rate (up to 20%–40%) among COVID-19 patients in hospital, a benign duration with 0% severity and mortality rates was shown by 21 HIV/AIDS patients. The severity rates of COVID-19 were comparable between non-AIDS (median CD4 = 287 cells/μl) and AIDS (median CD4 = 97 cells/μl) patients, despite some of the AIDS patients having baseline lung injury stimulated by HIV: 7 patients (33%) were mild (five in the non-AIDS group and two in the AIDS group) and 14 patients (67%) were moderate (six in the non-AIDS group and eight in the AIDS group). More importantly, we found that a reduction in T-cell number positively correlates with the serum levels of interleukin 6 (IL-6) and C-reactive protein (CRP), which is contrary to the reported findings on the immune response of COVID-19 patients (lower CD4 T-cell counts with higher levels of IL-6 and CRP). In HIV/AIDS, a compromised immune system with lower CD4 T-cell counts might waive the clinical symptoms and inflammatory responses, which suggests lymphocyte redistribution as an immunopathology leading to lymphopenia in COVID-19.

Highlights

Lymphopenia is a common feature in patients with severe coronavirus disease 2019 (COVID-19), with drastically reduced numbers of T cells (Chen et al, 2020)
HIV/AIDS naturally served as a T-cell exhaustion disease model for recognizing how the immune system works in the course of COVID-19 infection
Considering the clinical features, 11 patients were non-AIDS and 10 were AIDS presenters according to the Centers for Disease Control and Prevention (CDC) classification

Summary

Introduction

Lymphopenia is a common feature in patients with severe coronavirus disease 2019 (COVID-19), with drastically reduced numbers of T cells (Chen et al, 2020). A retrospective study of 522 patients with COVID-19 found that a clinical severity-dependent reduction in the number of T cells is inversely correlated with the serum level of interleukin 6 (IL-6) (Diao et al, 2020). Spleen atrophy was observed (Cao, 2020) These findings indicate that aggressive lymphocyte redistribution in the lungs was induced and that treatments to regulate immunity are needed for COVID-19 infection (Huang et al, 2020; Mehta et al, 2020; Qin et al, 2020; Wan et al, 2020; Wu and Yang, 2020)

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Conclusion