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EXPLAINED: How Search For Omicron Origin Has Put HIV Under Lens, And Why It All Points To Need For Vax Equity

Experts say that ensuring necessary treatment for HIV patients and expanding vaccine coverage to places that have suffered shortages should be the priority if the rise of new variants is to be prevented. (AFP)

Experts say that ensuring necessary treatment for HIV patients and expanding vaccine coverage to places that have suffered shortages should be the priority if the rise of new variants is to be prevented. (AFP)

Though there is no conclusive evidence, it is suspected that Omicron's rise could be linked to an HIV patient who may have carried the infection for a long time

Characteristics that have come to light of the novel coronavirus’s Omicron variant — the latest to be designated as a Variant of Concern (Voc) by the WHO — have led some to suspect that HIV infection, of which there is high incidence in southern Africa, may be linked with its rise. People with weakened immune systems represent likely hosts in whom the virus can take on mutations, though HIV is not the only condition that so affects a patient. Also, low vaccine coverage is not conducive to preventing mutations of the virus and experts have pointed to the grievous shortages of jabs that Africa faces even as the advanced nations race to administer booster shots to their population in response to Omicron.

Why Is HIV Being Linked To Omicron Rise?

Any virus, including the novel coronavirus, can linger for a long time inside the body of a person with weakened immunity, where it can take on new mutations. Immunocompromised, or immunosuppressed people can then pass on the new version of the virus to another person.

One of the impacts of a disease like HIV on the patient is to leave their immune systems compromised, which prevents them from fighting off diseases that healthy people can easily clear from their systems. It is believed that the longer a virus gets to persist within a person, the stronger are its chances to take on mutations.

Although not all mutations confer an evolutionary advantage on the virus, in a pandemic situation, given the large number of people who are infected, it is easier for the virus to eventually hit upon the right set of mutations that helps it infect people better and faster and also evade antibodies, qualities that the Omicron is said to possess, although experts say that it has so far been found to cause milder infection while vaccines still seem to work against the newest VoC.

The thinking among some virologists, reports say, is that VoCs first arose in immunocompromised hosts. The Alpha and Beta variants, which were first reported in 2020 in the UK and South Africa, respectively, are believed to have emerged from hosts who had long-term infection with Covid-19.

Now, southern Africa, including South Africa, has epidemic levels of HIV incidence with UNAIDS saying that in 2020, almost a fifth of all people aged between 15–45 years in South Africa were HIV positive. Further, only about 70 per cent of these patients are on antiretroviral therapy, which repairs the immune system and restores its ability to tackle diseases.

But there is no conclusive evidence of any linkage between HIV and Omicron. That it emerged from a person who carried a Covid-19 infection for a long time is based on the finding that the new variant does not display any genetic resemblance to the other VoCs but to the original novel coronavirus that was first identified in the central China city of Wuhan.

What Are The Arguments Against The HIV Origin Story?

The chance that Omicron arose in an HIV-infected person is just one hypothesis with experts pointing out that some other diseases, including advanced cancer, and organ transplant, too, can lead to a weakened immune system.

There is speculation also that Omicron was engendered after the novel coronavirus jumped from a human into an animal and then mutated and infected a new host. Given that it is genetically similar to the original strain, it has also been suggested that it arose and spread in an area with low medical surveillance — most areas in Africa would arguably match that description — before finally showing up in South Africa, which has a robust system for genetic sequencing of Covid-19 samples.

It has been argued that the HIV hypothesis came about only since southern Africa is known to have a high rate of HIV prevalence.

“The reason why this variant was associated with HIV is because it emerged in South Africa, where a lot of people are infected with HIV,” Vadim Pokrovsky, the head of the Special Research Department for Disease Control and AIDS Prevention at the Russian Central Research Institute of Epidemiology, was quoted by the government-owned TASS news agency. He added that that “there is no evidence” for these claims while also stating “most important is that HIV is not transmitted with this strain”.

“The initial version was that this strain appeared in the body of a person with immunodeficiency, it circulated in the body for a long time and therefore mutated. But this could have happened differently — the mutation occurred in the body of one person, a next one got infected from him, and there was another mutation. As a result, a lot of them accumulated,” he said.

As an expert at the University of Cambridge told Medical News Today, “The high prevalence of HIV in South Africa may have contributed to the evolution of the Omicron variant. However, it is important to emphasise that HIV is not the only disease [that] can cause immunosuppression in individuals.”

Dr Steven Kemp also reminded that “people living with HIV who control their virus are immunocompetent and are able to clear the virus like the rest of us”. Speculation on any link between HIV and variants of the novel coronavirus should not to lead to stigmatisation of HIV patients or people with compromised immune systems, but spur urgent actions to ensure the necessary treatment for them.

Meanwhile, amid talk that Omicron could become the dominant strain of the novel coronavirus, it has to be remembered that the Delta variant, first identified in India last year, still accounts for the overwhelming majority of all Covid infections and deaths worldwide.

How Does This Bring Us To Vaccination, HIV Treatment?

An undesirable side-effect of health systems shifting their focus to fighting the Covid-19 pandemic was the lowering of priority for treating other diseases. But as the concerns over HIV and variants show, compromising on addressing the one disease can potentially make the other more troublesome to handle.

“I do think we need to translate our sense of urgency from Sars-CoV-2 to HIV prevention and treatment in parallel to tackling uneven vaccine coverage globally,” Prof Penny Moore of the University of Witwatersrand in South Africa was quote by British daily The Guardian.

The importance of vaccines has been universally noted with scientists attributing the rise of new variants to the lack of even distribution of vaccines around the globe. As of December 19, while more than 50 per cent of eligible people in the Americas, Europe and Asia had been fully vaccinated against Covid-19, the figure stood at only 8 per cent for Africa.

Writing in the journal Nature, a group of experts said that the failure to tackle the Covid pandemic “with sufficient urgency” in countries with high rates of HIV “could lead to the emergence of variants of… Sars-CoV-2 that spread more easily between people or render the vaccines less effective”.

“Increasing access to Covid-19 vaccines will reduce that risk, for sure, and there is a worrying overlap between areas where HIV prevalence is high and Covid-19 vaccine coverage is low,” Prof Moore said.

As Medical News Today noted, “whether HIV contributed to the development of Omicron or not, experts widely believe that uneven vaccination rollout worldwide contributes to the evolution of SARS-CoV-2 variants”.

Also, despite apprehensions that Omicron might be able to blunt the protection offered by vaccines, experts maintain that jabs remain the best bet against severe infection and hospitalisation. As Dr Kemp points out, “Mutations found in the Delta and Omicron variants have been shown to partially evade immunity granted by existing vaccines, but they still afford high protection and result in far fewer ventilations and deaths”.

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first published:December 14, 2021, 09:28 IST