Sars-cov-2 seroprevalence and igg levels are lower among people living with hiv

ABSTRACT

Background: Although data are mixed, most cohorts show a similar or lower COVID-19 incidence among people living with HIV (PLWH) compared to the general population. However, incidence may be impacted by lower testing rates among vulnerable populations. We compared SARS-CoV-2 seroprevalence and IgG levels, and disease severity, among patients with and without HIV receiving care within a county hospital system over a three-month period. Methods: From August through October 2020, remnant serum samples were collected from all PLWH who underwent routine outpatient laboratory testing at San Francisco General Hospital which houses a large HIV clinic (Ward 86). Patients with HIV were matched on time of collection (same day) and age (+/- 5 years) to 1-2 adults without HIV. SARS-CoV-2 levels of IgG levels was quantified in serum using the Pylon IgG assay (100% specificity on internal validation). Seroprevalence was compared by HIV status via conditional logit models, adjusting for sex. For those with reactive results, IgG levels were compared by HIV status using log-transformed generalized estimating equations. Severe disease, assessed via chart review, was defined as requiring oxygen. Results: Among 1,411 individuals (46% PLWH), the median age was 58 (IQR 49-65), 64% were men. COVID-19 seroprevalence was 3.1% among PLWH compared to 6.8% among people without HIV (adjusted odds ratio 0.41;95% confidence interval (CI) 0.25-0.68, p<0.001). Among those with reactive COVID-19 IgG results (n=72, 20 in PLWH);antibody levels were 47% lower among PLWH (95% CI 19-65% lower;p=0.003;Figure);however, there was a trend towards higher disease severity among PLWH [15% (n=3) vs. 4% (n=2);p=0.13]. Conclusion: Both seroprevalence, and absolute SARS-CoV-2 IgG levels in those with reactive results, were lower among PLWH, within a time and agematched population of outpatients receiving routine laboratory testing in an urban hospital. PLWH may have had higher adherence to non-pharmaceutical interventions (NPIs) than those without HIV, leading to lower COVID-19 seroprevalence and, possibly, lower COVID-19 IgG levels if infected with a lower viral inoculum due to NPIs. Alternatively, PLWH may mount lower antibody responses to SARS-CoV-2, as has been demonstrated with hepatitis B and yellow fever vaccines. Further studies of COVID-19 susceptibility and immunity are needed among PLWH. Moreover, PLWH should be enrolled in SARS-CoV-2 vaccine studies or followed after vaccination to ensure they mount sufficient humoral responses.