Fig. 2.

Immune responses to SARS-CoV-2 infection in PWH depend on their immune competency. PWH with well-controlled HIV infection (effective ART) show a humoral and T-cell response comparable to HIV-uninfected individuals, as characterized by strong T-cell and antibody response targeting multiple regions across the SARS-CoV-2 viral genome. Conversely, in ART-naïve individuals with low CD4 counts, generation of T-cell responses is suboptimal and of reduced frequency. Antibody responses are also compromised, likely due to HIV-induced changes in the architecture of lymph nodes, skewing the B-cell response toward an extrafollicular pathway. The suboptimal nature of the immune response in this context may lead to delayed clearance of SARS-CoV-2, creating an environment conducive to viral evolution. ART antiretroviral therapy, NCD noncommunicable diseases, OI opportunistic infections, LN lymph node, GC germinal center, Sw Switched memory B cells (IgD-CD27+), DN IgD-CD27- double negative B cells