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In association with this, HIV also causes B cell dysregulation and dysfunction ( Moir and Fauci, 2013). The loss of CD4 T cells leads to dysregulation of many aspects of the immune response, including germinal center formation and antibody affinity maturation, which requires help from the highly HIV susceptible CD4 T follicular helper cells ( Okoye and Picker, 2013 Pallikkuth et al., 2012 Perreau et al., 2013). CD4 T cell death occurs after cellular infection with HIV ( Westendorp et al., 1995), or in bystander or incompletely infected cells due to activation of cellular defense programs ( Doitsh et al., 2010 Doitsh et al., 2014), and is halted and, to some extent, reversed by antiretroviral therapy (ART), even sub-optimal therapy ( Jackson et al., 2018). HIV depletes CD4 T helper cells ( Dalgleish et al., 1984) which are a critical part of the adaptive immune response and are also the main target of HIV infection. HIV is a prevalent infection in KwaZulu-Natal, South Africa ( Kharsany et al., 2018) which also has a high SARS-CoV-2 attack rate ( Tegally et al., 2021a Tegally et al., 2021b).
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