COVID-19 clinical presentation and SARS-CoV-2 viral kinetics in people living with HIV

ABSTRACT

Introduction/ Background: By August 2021, 6.2 million cases of COVID-19 have been reported in Africa, which has about 70% of the global burden of HIV. The purpose of this study was to assess SARS-CoV-2 viral load in people living with and without HIV. Methods: We screened 2174 ambulatory patients presenting at three primary healthcare facilities and enrolled 106 consenting individuals who tested positive for SARSCoV- 2 primarily during the second wave in Durban, South Africa. Participants were enrolled within three days of SARS-CoV-2 screening and were then followed up at day 7, 14 and 28, and at month 3 and 6 post screening visit. Data on SARS-CoV-2 Ct number, as well as laboratory parameters were collected blinded to HIV status. Results: All 106 participants presented with mild to moderate COVID-19. Thirty of 106 participants were HIV positive;26 (86.5%) were on ART, of which 21 (77.8%) were virally supressed. Their CD4+ T-cell count ranged from 286 to 843 with the median 500 cells/mm3. In the HIV infected cohort, longer viral shedding was associated with having a CD4+ T cell count <500 at enrolment (adjusted hazards ratio 0.31, 95% confidence interval 0.12-0.80, p=0.015). We observed no significant differences in the clinical presentation and disease outcomes of HIV infected and HIV uninfected COVID-19 patients. Impact Considering the implications that prolonged viral shedding could have on emergence of new viral variants and global vaccination efforts, HIV patients failing therapy should be prioritized for current prevention measures. Conclusion: Presence of HIV co-infection did not result in worsened clinical presentation in this cohort. Of note, we identified HIV infection with CD4 counts <500 as a potential driver of prolonged SARS-CoV-2 viral shedding.