COVID-19’s interaction with HIV and TB investigated

02 June 2020 | Story Claire Whitaker and Nobhongo Gxolo. Photo CIDRI-Africa. Read time 4 min.
Prof Robert Wilkinson, group leader at the Francis Crick Institute and director of CIDRI-Africa.
Prof Robert Wilkinson, group leader at the Francis Crick Institute and director of CIDRI-Africa.

The HIATUS study, a research programme being launched by the Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa) at the University of Cape Town (UCT), will investigate the interaction between the COVID-19 pandemic and common endemic infectious diseases in the South African context.

CIDRI-Africa will launch a programme of projects focused on understanding and providing information on the clinical presentation and pathogenesis of COVID-19 in the South African population. COVID-19 is the disease caused by the newly emerged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

The “health facility-based observational studies to investigate interaction and overlap between SARS-CoV-2, M. tuberculosis and HIV-1 infections” programme will take place at Groote Schuur Hospital and the Site B Community Health Centre in Khayelitsha, Cape Town, and Livingstone Hospital in Port Elizabeth.

Principal investigator Professor Robert J Wilkinson, a member of the Institute of Infectious Disease and Molecular Medicine and director of CIDRI-Africa, said, “It is important to understand not only the COVID-19 infection itself but also its potential interaction with common endemic infectious diseases in South Africa, which are HIV-1 and tuberculosis [TB].”

As part of the HIATUS study, researchers in the programme of four related projects will invite hospitalised COVID-19 patients to donate small extra samples of blood and cerebrospinal fluid during normal care procedures. From these samples, the researchers hope to glean a wealth of information about the pathology of and immune response to SARS-CoV-2 in people with and without HIV or TB co-infection.

The study will start once feedback from the Institutional Biosafety Committee is received.

TB and HIV in South Africa

According to the World Health Organization’s (WHO) Global Tuberculosis Report 2019, South Africa carries about 3% of the global incidence of TB. A 2019 profile of South Africa developed by the Joint United Nations Programme on HIV/AIDS stated that 20% of the HIV prevalence in the world occurs in South Africa.

TB in 2018

  Global South Africa
Cases 10 000 000 301 000
HIV positive TB deaths 251 000 42 000
HIV/TB cases 862 000 177 000


HIV in 2018

  Global South Africa
Prevalence 37 900 000 7 700 000
New infections 1 700 000 240 000
AIDS deaths 770 000 71 000

As reported on the WHO COVID-19 Dashboard, 6 040 609 cases of COVID-19 have occurred across the globe to date. Of these, 32 683 (0.5%) have occurred in South Africa, according to the National Institute for Communicable Diseases.

There are grave concerns about the impact that COVID-19 might have in South Africa owing to considerable existing epidemics like HIV and TB, which may increase vulnerability to and severity of COVID-19 infection. However, the consequences of SARS-CoV-2 co-infection alongside HIV and TB are at present unknown.

There is an urgent need for us to better understand the clinical manifestations and pathogenesis of SARS-CoV-2 in order to develop tools, strategies and interventions to stop the spread of disease and improve treatment within our unique population. CIDRI-Africa will contribute to meeting this need through the various projects of the HIATUS study.


“We anticipate these studies will provide important information on COVID-19 infection that will be directly relevant to African populations.”

HIATUS projects

In the first HIATUS project, the team will investigate the SARS-CoV-2-specific response of immune cells called T-cells and determine whether these responses correlate with disease outcomes. Results from this study could also provide the basis for a simplified test to assess viral immunity.

In the second project, CIDRI-Africa researchers will examine the role of specific pathological phenomena, such as clotting and cytokine storms in COVID-19. Cytokine storms are severe and potentially life-threatening hyperinflammatory immune reactions in which the body releases a flood of cellular signalling molecules.

Although COVID-19 is primarily a respiratory disease, it is increasingly evident that there are also neurological effects, such as anosmia (loss of smell), which suggests that the virus may infect the nerves and brain. CIDRI-Africa’s team will therefore describe and characterise the prevalence, clinical presentation, biochemistry and severity of neurological COVID-19 in their third project.

In their last project, researchers will extend an existing TB close-contact study by including COVID-19 screening and testing in future clinic visits.

“We anticipate these studies will provide important information on COVID-19 infection that will be directly relevant to African populations,” said Wilkinson.

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