Why uncontrolled HIV may be behind the emergence of Omicron

Where did Omicron come from? By all accounts it is a weird variant. Though highly mutated, it descended not from one of the other variants of concern, such as Alpha, Beta or Delta, but from coronavirus that was circulating maybe 18 months ago. So where has it been all this time? And why is it only wreaking havoc now?

Researchers are exploring a number of hunches. One is that Omicron arose in a remote region of southern Africa but failed to spread until now. Another is that it evolved in infected animals, such as rats, and then crossed back into humans. But a third explanation is gaining ground as more data come to light, that Omicron arose in a person with a weakened immune system: someone having cancer treatment perhaps, an organ transplant patient or someone with uncontrolled HIV.

The latter possibility has sparked global concern. Sub-Saharan Africa is home to two-thirds of the global population living with HIV. For a whole series of reasons, ranging from lack of access to clinics to fear of stigmatisation and disrupted healthcare, 8 million people in the region are not on effective HIV therapy.

Beyond the direct problems this causes with disease progression and vulnerability to Covid – people with advanced or uncontrolled HIV are far more likely to die from coronavirus – is the risk that uncontrolled HIV is driving the emergence of Covid variants.

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