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Comparison between non-pulmonary and pulmonary immune responses in a HIV decedent who succumbed to COVID-19
  1. Denise Goh1,
  2. Justina Nadia Lee1,
  3. Tracy Tien1,
  4. Jeffrey Chun Tatt Lim1,
  5. Sherlly Lim1,
  6. An Sen Tan2,
  7. Jin Liu3,
  8. Benedict Tan1,
  9. Joe Yeong1,4,5,6,7,8
  1. 1 Institute of Molecular and Cell Biology, Agency of Science, Technology and Research (A*STAR), Singapore
  2. 2 Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
  3. 3 Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
  4. 4 Cancer Science Institute of Singapore, National University of Singapore, Singapore
  5. 5 Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  6. 6 Department of Pathology, University of Western Sydney, Greater Western Sydney, New South Wales, Australia
  7. 7 Singapore Immunology Network, A*STAR, Singapore
  8. 8 Department of Anatomical Pathology, Singapore General Hospital, Singapore
  1. Correspondence to Dr Joe Yeong, Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore; yeongps{at}; Dr Jin Liu, Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore; jin.liu{at}; Dr Benedict Tan, Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore; benedict_tan{at}

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We read with interest the study by Manuel et al showing that chronic immunosuppression could protect against severe COVID-19 in liver transplant patients.1 Despite increased comorbidities, COVID-19 in liver transplant patients was not more severe than in non-transplant cohorts.1 2 We present findings from a COVID-19/HIV coinfected decedent who exhibited a significantly longer survival time (46 days) than that of three COVID-19 decedents (average 30 days) (figure 1A). Given the immunosuppressive effects of HIV,3 the prolonged survival of our COVID-19/HIV patient may reflect protection from severe COVID-19.

Figure 1

Increased myeloid and reduced T-cell abundance characterises the liver and kidney but not the lungs of a COVID-19/HIV decedent. (A) Kaplan-Meier survival curve of COVID-19/HIV case (nCOVID-19/HIV = 1) and COVID-19 cases (nCOVID-19=3). P-value: Log-rank (Mantel-Cox) test. (B) Representative regions of interest (ROI) of the liver, kidney, and lung from the COVID-19/HIV decedent and one COVID-19 decedent. (C) Principal component analyses of transcriptional profiles of COVID-19/HIV and COVID-19 decedents from ROIs of the lung (nCOVID-19/HIV = 11, nCOVID-19=29), liver (nCOVID-19/HIV = 10, nCOVID-19=32), and kidney (nCOVID-19/HIV = 11, nCOVID-19=8). (D) Relative estimated levels of immune cells determined by deconvolution of digital spatial profiling ROIs using CIBERSORTx ( Grey bars indicate the means. P-values were calculated by a two-tailed t-test: *(<0.05), **(<0.01), ***(<0.001), ****(<0.0001), ns (not significant). (E) Comparison of the abundance of various immune cell populations between ROIs of the COVID-19/HIV decedent and COVID-19 decedents by multiplex immunohistochemistry. P-values were calculated by a two-tailed U-test: *(<0.05), ns …

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  • DG, JNL, TT and JCTL are joint first authors.

  • JL, BT and JY are joint senior authors.

  • DG, JNL, TT and JCTL contributed equally.

  • Correction notice This article has been corrected since it published Online First. Author affiliations have been updated.

  • Contributors JY, BT and JL conceived and directed the study. DG, AST, BT and JL collated and interpreted the data and performed biostatistical analysis. JNL, TT, SL and JCTL performed immunohistochemical techniques and scoring. DG and BT drafted the manuscript and final approval of all authors.

  • Funding The authors received funding from A*STAR Career Development Award (C21112056).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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