Álvarez, HortensiaRuiz-Mateos, EzequielJuiz-González, Pedro MiguelVitallé, JoanaViéitez, IreneVázquez-Friol, María Del CarmenTorres-Beceiro, IsabelPérez-Gómez, AlbertoGallego-García, PilarEstévez-Gómez, NuriaDe Chiara, LorettaPoveda, EvaPosada, DavidLlibre, Josep M2023-05-032023-05-032022-01-112076-2607http://hdl.handle.net/10668/21431Intra-host evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been reported in cases with persistent coronavirus disease 2019 (COVID-19). In this study, we describe a severely immunosuppressed individual with HIV-1/SARS-CoV-2 coinfection with a long-term course of SARS-CoV-2 infection. A 28-year-old man was diagnosed with HIV-1 infection (CD4+ count: 3 cells/µL nd 563000 HIV-1 RNA copies/mL) and simultaneous Pneumocystis jirovecii pneumonia, disseminated Mycobacterium avium complex infection and SARS-CoV-2 infection. SARS-CoV-2 real-time reverse transcription polymerase chain reaction positivity from nasopharyngeal samples was prolonged for 15 weeks. SARS-CoV-2 was identified as variant Alpha (PANGO lineage B.1.1.7) with mutation S:E484K. Spike-specific T-cell response was similar to HIV-negative controls although enriched in IL-2, and showed disproportionately increased immunological exhaustion marker levels. Despite persistent SARS-CoV-2 infection, adaptive intra-host SARS-CoV-2 evolution, was not identified. Spike-specific T-cell response protected against a severe COVID-19 outcome and the increased immunological exhaustion marker levels might have favoured SARS-CoV-2 persistence.enAttribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/CD4+ T cell responseHIVSARS-CoV-2research article35056592open access10.3390/microorganisms10010143PMC8780218https://www.mdpi.com/2076-2607/10/1/143/pdf?version=1641893176https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8780218/pdf