Thread by @LizHighleyman

It's been a long day at #CROI2023, but I'll attempt to live-tweet @MichaelPelusoMD's presentation on #longCOVID. Though mainly an #HIV meeting, CROI also includes the hot infectious diseases of the day. (Thanks Dr Peluso for providing advance slides & permission to share.) 1/

@MichaelPelusoMD .@MichaelPelusoMD & colleagues' SCOPE cohort at @UCSF + international collaborators have now studied more than 700 people with #longCOVID 2/

.@MichaelPelusoMD at #CROI2023: #LongCOVID is many things. 3/

.@MichaelPelusoMD at #CROI2023: Many risk factors for #longCOVID. Open questions are how will reinfection & treatment of acute SARS-CoV-2 infection change the picture. 4/

.@MichaelPelusoMD at #CROI2023: Several possible mechanisms for #longCOVID including persistent infection & inflammation. He says at start of COVID he would have said difference btwn SARS-CoV-2 & #HIV is HIV persists -- but he's rethought that given growing evidence. 5/

.@MichaelPelusoMD at #CROI2023 6/

Inflammation consistently identified in #longCOVID. Some research suggests lack of coordination among immune responses. Some patterns of immune dysregulation differ between men & women. #CROI2023 7/

Reactivation of other latent common viruses. Tim Henrich et al found EBV reactivation was associated with worse COVID symptoms, but CMV went in the other direction – less likely to have LC symptoms. Are these other viruses drivers or bystanders? 8/ #CROI2023

Microbial translocation is associated with worse #longCOVID symptoms in some studies. #CROI2023 9/

Autoimmunity is better understood in acute COVID -- but during long COVID evidence is much more mixed. #CROI2023 10/

Growing evidence about microclotting, but role is unclear. #CROI2023 11/

.@VirusesImmunity's found higher cortisol level was most distinguishing factor between #longCOVID & fully recovered. It's being validated now in other cohorts – and researchers are trying to determine biological mechanism for association. #CROI2023 12/

.@MichaelPelusoMD: All these different factors are in silos, individual mechanism are being studied by different specialties -- but we need to integrate them. #CROI2023 13/

.@MichaelPelusoMD: We need #longCOVID biomarkers. Validation of #HIV viral load as a biomarker for AIDS revolutionized the field & development of therapies. But people with LC can’t wait. #CROI2023 14/

Fortunately, all of these mechanisms are potentially targetable. #CROI2023 15/

We need both more small pathogenesis studies + big diverse cohorts like RECOVER + large volume sample repositories + robust & inclusive clinical programs like we have for HIV -- all need support & funding. #CROI2023 16/

Audience asks about impact of menopause, #longCOVID in children. @MichaelPelusoMD thinks biological differences by sex are going to be very important. Probably more emphasis than there should be on LC in kids – but interested in what’s going on with adolescents. #CROI2023 17/

Terri Wilder (@WildNycgirl): There are many similarities between #longCOVID & #MECFS. If people had done something about ME/CFS years ago we wouldn’t be starting where we are today with #longCOVID. #CROI2023 18/

.@MichaelPelusoMD: #LongCOVID is real & its impact is profound. As with #HIV, community engagement & advocacy are key. Everyone in this room needs to be an advocate. I'm hopeful we’ll be able to get answers for #longCOVID -- & that will also benefit people w/ MECFS. #CROI2023 /19

.@MichaelPelusoMD had to speak fast to summarize what we know about #longCOVID in 15 mins & I couldn't catch it all. Suffice it to say there's a *lot* of research going on, which I hope to cover further.
(But now -- off to write about today's #monkeypox news) #CROI2023 /end

I know there's debate about whether #longCOVID is "real" & whether its physiological or psychosomatic. I just know that if prominent HIV researchers I've covered for years -- like Deeks, Henrich & McComsey -- take it seriously, I'm going to take it seriously too. #CROI2023

Of historical interest, in 2010 & 2011 CROI included content about XMRV, a mystery retrovirus once linked to #MECFS & prostate cancer. I covered it quite a bit -- we were hopeful that finding a viral cause could point toward effective treatment. #CROI2023
hivandhepatitis.com/other-health-n…

It turned out to be a case of laboratory contamination. Judy Mikovitz, mostly recently of "Plandemic" fame, played a starring role -- I don't think she's ever acknowledged the error.
washingtonpost.com/nation/2020/05…

Here’s one of the most important summary slides from @MichaelPelusoMD’s #longCOVID talk yesterday. It’s an animated slide that didn’t show up in completely in the deck, so here’s a screenshot.

CLARIFICATION: The @UCSF #LongCOVID cohort is called LIINC. They leveraged the resources of SCOPE -- their long-running HIV cohort -- for the LC research & I got them confused.