ABSTRACT
Background: Asymptomatic COVID-19 is common among the general population, but little has been reported on this phenomenon among people with HIV (PWH) globally. Here we present data on a representative subset of 2,464 REPRIEVE participants with blood collected for COVID-19 serology from May 2020 to February 2021. Methods: REPRIEVE is an international primary atherosclerotic cardiovascular disease (ASCVD) prevention RCT of pitavastatin calcium vs. placebo among 7,770 PWH ages 40-75 on antiretroviral therapy (ART). Beginning in April 2020, targeted data on COVID-19 diagnosis and symptoms were collected as part of routine trial visits every 4 months, and blood was collected annually to assess SARS-CoV-2 serology. SARS-CoV-2 infection was defined as either presence of SARS-CoV-2 IgG or IgA RBD protein (anti-spike) antibodies or reporting of confirmed COVID-19 disease prior to the date of antibody sampling in the absence of prior COVID-19 vaccine receipt. We distinguished symptomatic from asymptomatic disease based on completed COVID-19 symptom questionnaire. Demographic, cardiometabolic, and HIV-specific data are described among those with symptomatic versus asymptomatic COVID-19 disease. Results: Participant characteristics (n=2464) included median age 53 years, 35% female sex, 47% Black or African American race, median CD4 count 649 c/mm3, and 97% with HIV VL <400 cp/mL. SARS-CoV-2 infection occurred in 318 persons (13%): 58 with clinical disease diagnosis and 260 with reactive Abs but no reported clinical disease. Of these persons, 304 completed symptom questionnaires: 120 (39%) reported at least 1 symptom of COVID-19 disease, but 184 (61%) reported no symptoms. PWH with asymptomatic infection were more likely to be from non-High Income Regions, of Black or African American race, and to be non-obese (Table). Median ASCVD risk score was <5% (low risk) for the two groups. Potential differences in symptomatic disease based on ART-regimen were noted, but no clinical differences between the groups for CD4 counts or HIV viral suppression were observed. Conclusion: Asymptomatic SARS-CoV-2 infection is very common among ART-treated PWH globally. With Ab testing, we determined that 61% of COVID-19 infections were asymptomatic in the REPRIEVE cohort, similar to rates reported in the general population. HIV clinicians must remain vigilant about COVID-19 testing among PWH to assure that asymptomatic cases are identified.
ABSTRACT
Background: Little is known regarding global COVID-19 vaccination rates in people with HIV (PWH), a population with significant morbidity from COVID-19. The Randomized Trial to Prevent Vascular Events (REPRIEVE) is a global primary cardiovascular prevention trial among PWH (N=7770) with representation from >100 sites across twelve countries (Brazil, Botswana, Canada, Haiti, India, Peru, Spain, South Africa, Thailand, Uganda, USA, Zimbabwe). Data collected on COVID-19 vaccination rates in REPRIEVE afford a unique opportunity to assess such rates among PWH across global regions. Methods: We assessed cumulative COVID-19 vaccination rates from January through July 2021 among 6952 active participants and compared rates to region-and country-specific vaccination data among the general population, determined from publicly available datasets (CDC, World Bank). Secondarily, within the REPRIEVE cohort, demographic, cardiovascular, and HIV-specific data were compared among those vaccinated vs not via Kaplan-Meier. Results: The cumulative probability of COVID-19 vaccination through the end of July 2021 was 47% among REPRIEVE participants, with rates varying substantially by global burden of disease (GBD) super-region and specific countries. Cumulative vaccination rates (Figure) were highest in the High-Income super-region (64%), followed by Latin America and the Caribbean (51%), Southeast/East Asia (36%), South Asia (16%) and Sub-Saharan Africa (12%). Country-specific rates varied dramatically, with vaccination rates highest in the United States, Peru, and Brazil, 67%, 60%, and 55%, and lowest in South Africa, Uganda, and Haiti with 11%, 3%, and 0%, respectively. Overall factors associated with COVID-19 vaccination among PWH included age, White race, natal male sex, BMI, and higher burden of cardiovascular risk factors, with important differences across GBD super-regions by log-rank test. Vaccination rates among PWH in REPRIEVE were largely comparable to the general population, in most GBD super-regions (Figure), though differences were observed in comparison to the general population in specific countries (data not shown). Conclusion: Global inequities in COVID-19 vaccine access among PWH are apparent, with highest vaccination rates observed among those residing in high-income regions. In addition to region, factors associated with vaccination among PWH included White race, natal male sex, and higher burden of CVD risk factors. Efforts are needed to increase global and regional vaccine rates for PWH.