Curious case of HIV positive woman's '216-day Covid-19 fight'

The virus, the report claims, accumulated more than 30 mutations during the period

An unusual case study of an HIV positive woman with ‘prolonged Covid infection for 216 days’ has been grabbing headlines.

The 36-year-old South African was hospitalised in September 2020 after reporting sore throat, cough and dyspnoea, and has since spent 216 days with Covid-19 infection. During this period, the virus gathered over 30 mutations, the report said.

The woman, on HIV antiretroviral therapy (ART) since 2006, had started exhibiting Covid symptoms 12 days before she was admitted to the hospital.

Her medical history included ‘a single episode of tuberculosis in 2006, and chronic asthma for which she received inhaled budesonide and salbutamol’, stated the report.

She spent nine days in a general Covid ward on oxygen support, six days out of which she was administered dexamethasone.

The virus, the report claims, accumulated more than 30 mutations, including 13 to the ‘spike proteins’ and 19 other genetic shifts.

“While most people effectively clear SARS-CoV-2, there are several reports of prolonged infection in immunosuppressed individuals. Here we present a case of prolonged infection of greater than 6 months with shedding of high titter SARS-CoV-2 in an individual with advanced HIV and antiretroviral treatment failure. Through whole genome sequencing at multiple time-points, we demonstrate the early emergence of the E484K substitution associated with escape from neutralising antibodies, followed by other escape mutations and the N501Y substitution found in most variants of concern. This provides support to the hypothesis of intra-host evolution as one mechanism for the emergence of SARS-CoV-2 variants with immune evasion properties”, the study summarised.

The study is, however, yet to be peer-reviewed.