Review COVID-19 is "Airborne AIDS": Provocative oversimplification, emerging science, or something in between? Salamon, Pretorius et al, 2025

Kalliope

Senior Member (Voting Rights)

Highlights​

• HIV/AIDS and COVID-19 are preventable infectious diseases with chronic systemic impacts including immune system dysfunction.

• Chronic inflammation, immune exhaustion, and accelerated biological aging are shared hallmarks of HIVI/AIDS and Long COVID/PASC.

• Tissue reservoir persistence drives long-term damage in both HIV and SARS-CoV-2. SARS-CoV-2 mirrors HIV-1 in its ability to evade immune defenses and cause chronic infection.

• SARS-CoV-2 -associated neurological disorders (SAND) parallel HIV-associated neurological disorders (HAND).

• Both pandemics exhibit failures in global solidarity and reveal inequities in healthcare access.

Abstract​

Immune dysfunction and systemic effects in HIV and SARS-CoV-2 infections are distinct, but share relevant similarities and downstream consequences.

We compare and contrast observations of the immunological impacts of COVID-19 and HIV infections.

By examining shared and distinct mechanisms, such as immune dysfunction, vulnerability to opportunistic infections, accelerated aging and neurocognitive disorders, we highlight critical parallels and their implications.

We review the extensive scientific evidence showing that SARS-CoV-2 infections result in immune cell depletion, dysfunction, and exhaustion, with impacts on several immune system cell types. Higher rates of individual susceptibility to infections lead to population-wide increases in diverse infectious diseases, including those that are signatures of immunodeficiency.

Finally, we characterize societal responses to both pandemics, providing insights into public health strategies and lessons for improving current and future research, treatment, preparedness and mitigation efforts.

 
This is completely anecdotal, but I did meet the AIDS diagnostic criteria after a confirmed Covid infection in 2023 that made me severe. Thankfully my CD4 recovered over the next several months and is now in the normal range. I also tested negative for HIV several times. I have CD4 data before the Covid infection too so it is unlikely to have been something else. So at least for me, for 1 Covid infection, Covid was airborne AIDS.
 
As Emily Lim Rogers has analysed, analogies with AIDS like this are likely to be pretty unhelpful. The scientific case made here is muddled and misleading. If one thing we do know, it is that the mechanism of Long Covid is nothing like that of HIV. Thank goodness we also have some bona fide science to read - about TLR7 and female preponderance from Johns Hopkins.
 
As Emily Lim Rogers has analysed, analogies with AIDS like this are likely to be pretty unhelpful. The scientific case made here is muddled and misleading. If one thing we do know, it is that the mechanism of Long Covid is nothing like that of HIV. Thank goodness we also have some bona fide science to read - about TLR7 and female preponderance from Johns Hopkins.
I find it very hard to find out what the current and scientifically reliable view of Covid is at present. No one seems to be responsible for providing any kind of update of current knowledge, particularly one that would be accessible to the lay person - including the lay people who make up our governments and are responsible for pulling the political levers that allow major public health initiatives to be taken, including better ventilation, the resumption of surveillance, etc. etc.

I have no idea what kind of world I'm living in with Covid. Do you know how we can find out?
 
I have no idea what kind of world I'm living in with Covid. Do you know how we can find out?

S4ME is much the best source of information I know of, including the most up to the minute research. Pretty much anything useful known about Covid has been discussed here I think.

What sort of things would you want to know? We know the virus. We know what it's spike protein does. We have information on strains and waves of infection. We know about risk factors for severe illness. We know stuff about masks and we know that most people don't really care.
 
S4ME is much the best source of information I know of, including the most up to the minute research. Pretty much anything useful known about Covid has been discussed here I think.
We don't summarise what's known, though - we have multiple threads. some hundreds of posts long, discussing the ins and outs of the research - I can't possibly keep up and and it's way over my head.
What sort of things would you want to know? We know the virus. We know what it's spike protein does. We have information on strains and waves of infection. We know about risk factors for severe illness. We know stuff about masks and we know that most people don't really care.
I'd like to know everything that a lay person who doesn't know anything would like to know! So how does the virus operate in the body, what are the long-term effects, what are the effects of repeat exposure, is there evidence of a long-term reservoir of virus, how effective are the vaccines, what are the risks of the vaccines, what new vaccines (all-variants, nasal etc.) are in the pipeline and how could they change things, how much ill health are we racking up as a society, what is the likely future of Covid in terms of severity, transmissibility, etc. etc. etc.

Basically, anything that a scientist knowledgeable about Covid would want to tell an intelligent lay person who wants to understand the state of play, if they were writing a long-read article about it.
 
I'd like to know everything that a lay person who doesn't know anything would like to know!

Yes, but there aren't simple answers to most of these questions that will provide useful information for someone who does not know about the background.

It is a bit like asking to be told about the UK economy. There are all sorts of answers, full of caveats, to all sorts of questions but unless the listener has a good grasp of economics they may well not be very helpful.

Nobody has answers to most of the long term questions because we don't know the long term yet.
 
Scientists do seem to have come to conclusions about the current vaccines—that they aren't very effective and haven't been for some time, partly due to high levels of existing immunity.

They're really poor at preventing infection, and therefore transmission. Their role is in trying to screen high-risk people from severe and life-threatening complications. It doesn't seem to be easy to measure how successful that is, but the cost-benefit analysis currently comes down on the side of vaccinating them because it might help.

One of the things people with ME/CFS probably need to know is whether infection will make their underlying severity worse. But that seems to follow a similar pattern to reactions to the 'flu jab in ME/CFS—some people have no after-effects, others do but no worse than folk without ME/CFS, and some are absolutely floored by it. It seems hard to predict until you've had it once or twice, which is a fat lot of help.
 
Yes, but there aren't simple answers to most of these questions that will provide useful information for someone who does not know about the background.

It is a bit like asking to be told about the UK economy. There are all sorts of answers, full of caveats, to all sorts of questions but unless the listener has a good grasp of economics they may well not be very helpful.

Nobody has answers to most of the long term questions because we don't know the long term yet.
But even knowing the range of uncertainty would be helpful. The alternative is to have one's opinion and understanding just flapping in the breeze of the latest opinion on the internet.
 
I’m sure I’ve written this out on another thread but since it’s relevant I’ll put it here as well:

The gold standard for proving a viral reservoir is a quantitative viral outgrowth assay, in which healthy cell cultures are exposed to cells suspected to harbor the virus from a human or animal model. If the viral titres in the culture show evidence of the healthy cells supporting new infection, then and only then can you conclude that viral persistence was occurring. This can be a difficult assay to do if you have very low level viremia in the reservoir tissue, but the reason it’s the gold standard is because any other method of detecting the virus in a host is highly subject to confounding. Phagocytotic immune cells can hold onto viral proteins and RNA for months if not years.

I have so far seen one COVID-19 paper attempt to do a qVOA assay from a group that is well trained to do it in an HIV context and it showed negative results. Given how many people are pushing a viral persistence hypothesis, I suspect many more attempts have been tried, failed, and just not published. All the published literature showing “proof” of viral persistence has shown protein fragments or viral RNA, which could easily have been leftover junk in macrophages from prior infection (or even just from vaccination, since many studies only looked at spike protein).

If anyone does manage a successful qVOA assay with replication for COVID-19 I suspect it will be immediately published in Nature and we would all hear about it. It really does boggle my mind that I’m seeing so many publications state viral persistence as proven fact—I suspect some of them just don’t have enough familiarity with virology to know the limitations of existing findings, but others should know better.
 
What might be true, but has not been conclusively proven, is that these fragments might be enough to elicit immune responses long term and potentially cause some of the post-COVID findings we’ve been seeing. I’ve seen many studies showing changes in immune populations months or a few years out from initial COVID infection, some better quality than others, with inconsistency in the exact findings. At this point I’d personally feel comfortable concluding COVID does alter the immune system, just as many other viral agents are known to do, but there’s quite a bit of person-to-person variability that may mean quite different outcomes.

I agree with JE that we simply don’t know most of the long term outcomes because not enough time has passed to study them, and that the comparison to HIV is ultimately unhelpful. There are some documented changes in CD4+ populations, some of which hold up more than others, but this is of a completely different caliber than the life-threatening lymphocyte depletion seen in AIDS. Some individuals may show substantial differences in cell counts in the short term after COVID infection, but this is likely a function of other predispositions rather than something we can say happens after all COVID infections.
 
You need to pay attention, Sasha!! You are quite capable of understanding all this stuff we discuss.
But I'm not following it! There's way too much of it and I don't have the time or the mental bandwidth to follow it. I'm not suggesting that the forum puts something together - rather, given that this is an issue of global importance and society is awash with ignorance and misinformation about Covid, governments and respected scientific bodies ought to be putting out solid and up-to-date information that treats their populations like adults. This is an ongoing crisis and we're seeing nothing.
 
My understandings, for what they're worth (possibly nothing!):

how does the virus operate in the body
We still seem to be uncovering new bits of evidence or insights about this. It's a newish virus, so it probably won't come out in the wash for some years.

what are the effects of repeat exposure
We don't know, probably because it's not being studied systematically. The fact that so many people don't know whether they're infected, or how many times they've had it, makes that somewhat difficult. But of course being in that situation has been influenced strongly by political choices.

is there evidence of a long-term reservoir of virus
Haven't looked for information about this.

what new vaccines (all-variants, nasal etc.) are in the pipeline and how could they change things
Who knows, we might get some more convenient ones, but I suspect interest might be waning. If governments aren't guaranteed to buy new vaccines in bulk, there's less incentive for companies to keep developing them.

We seem to have reached a stage where there needs to be a major new event before policy and attitudes on Covid will shift.

how much ill health are we racking up as a society
That'll need time to unravel. All outcomes are possible, including that since vaccines became available, long term effects are no worse than other endemic viruses. But also that it's been a public health disaster.

what is the likely future of Covid in terms of severity, transmissibility,
I've read suggestions that although it's not comparable to 'flu, the practical effects might resemble it—infection comes in waves, and sometimes the successful variants are much more likely to cause serious complications than others. But it mutates many times faster than 'flu, and asymptomatic infection makes it more transmissible. People with 'flu aren't usually going to work or sitting in busy pubs.

Everyone's been hoping it becomes just another coronavirus that causes mild cold symptoms, which nearly everyone recovers from quickly. I guess we'll see.
 
What I find frustrating is that covid is largely airborne, and, considering the ridiculous politicization of masking, we in the U.S. could have encouraged better ventilation and air purification in public spaces to lower covid transmission. Maybe generous tax breaks for complying businesses would do that. Surely that wouldn't be politicized, but then again, I can imagine some Americans saying they don't want to breathe "woke" air. Sigh.
 
What I find frustrating is that covid is largely airborne, and, considering the ridiculous politicization of masking, we in the U.S. could have encouraged better ventilation and air purification in public spaces to lower covid transmission. Maybe generous tax breaks for complying businesses would do that. Surely that wouldn't be politicized, but then again, I can imagine some Americans saying they don't want to breathe "woke" air. Sigh.
Eh, not a single country actually did that. It's a human thing. We value things far more than we value human lives, which is only as far as labour potential goes, and always assuming that more bodies can be found if needed, so not much. The same apparently goes whatever government is in charge. Sweden and the USA are basically identical in their response, both during and since.

Because it's basically guaranteed that the failure of RECOVER to produce any results will be blamed on the chaos, entirely overlooking that they had 4 full years of normal government, and still produced nothing at all, all on top of decades of also doing nothing useful to help. If anything, chaotic governments might actually be useful as cover for what are otherwise almost universal failures.
 
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