HIV and SARS-CoV-2 INFECTION among POSTPARTUM KENYAN WOMEN and THEIR INFANTS

ABSTRACT

Background: People living with HIV may have increased risk of SARS-CoV-2 infection and severe COVID-19. However, few studies have examined the risk and outcomes of SARS-CoV-2 infection specific to postpartum women living with HIV and their HIV-exposed, uninfected (HEU) infants. To address this gap, we compared incidence, risk factors, and symptomatology of SARS-CoV-2 infection among mother-infant pairs living with and without HIV. Methods: We conducted a nested study of healthy mothers and infants enrolled in a Nairobi, Kenya-based prospective cohort study. Women living with HIV were enrolled in the parent cohort only if on antiretroviral therapy (ART) for ≥6 months. SARS-CoV-2 serology was performed on plasma collected between 1 May-31 December 2020 to assess incidence of infection and duration of antibody detection. SARS-CoV-2 RNA PCR and sequencing was also conducted on stool from seropositive participants. Sociodemographic and clinical data were used to evaluate risk factors for SARS-CoV-2 with Cox regression and to assess symptomatic COVID-19 with generalized estimating equations. Results: Among 104 mothers (51 living with HIV, 53 HIV-uninfected) and 89 infants (41 HEU, 48 HIV-unexposed), SARS-CoV-2 seropositivity was 38% and 17%, respectively. Incidence of infection did not differ significantly between women living with HIV and HIV-uninfected women (Hazard Ratio [HR]=1.51, 95% CI0.78-2.94) or HEU and HIV-unexposed infants (HR=1.48, 95% CI0.54-4.09). Maternal SARS-CoV-2 substantially increased risk of infant infection, regardless of HIV exposure (HR=10.3, 95% CI2.89-36.8). However, no other factors-including CD4 count and years on ART among women living with HIV-were associated with infection. Antibody levels waned below detection in ∼30% of mothers and infants after a mean of 6 and 5 months, respectively. Among seropositive participants, SARS-CoV-2 RNA was detected among 5 of 27 mothers (19%) and one of 13 infants (8%) with samples. Sequences recovered from 2 samples were related to circulating variants in Kenya in 2020. One-fifth of participants had mild to moderate symptoms, but there were no cases of severe COVID-19 or death. Conclusion: Our findings show there was a high risk of SARS-CoV-2 infection among postpartum Kenyan women and their infants in 2020, though this risk was not substantially increased for women with well-managed HIV and most cases were asymptomatic. Rapidly waning antibody responses suggest continued preventive measures are needed until vaccination is widely available.