Asymptomatic SARS-CoV-2 Infection Is Common Among ART-Treated People With HIV

Abstract

Background: Limited data are available regarding asymptomatic COVID-19 among people with HIV (PWH). Data on a representative subset of PWH enrolled in Randomized Trial to Prevent Vascular Events in HIV, a global clinical trial, are presented here. Methods:Randomized Trial to Prevent Vascular Events in HIV is an atherosclerotic cardiovascular disease prevention trial among 7770 PWH on antiretroviral therapy. Beginning April 2020, targeted data on coronavirus disease 2019 (COVID-19) diagnosis and symptoms were collected during routine trial visits. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was defined as either COVID-19 clinical diagnosis or presence of SARS-CoV-2 Immunoglobulin G (IgG) or Immunoglobulin A (IgA) receptor binding domain protein (antispike) antibodies in the absence of prior COVID-19 vaccine. Results:The group (N = 2464) had a median age 53 years, 35% female sex, 47% Black or African American race, median CD4 count 649 c/mm 3 , and 97% with HIV VL ,400 cp/m. SARS-CoV-2 infection occurred in 318 persons (13%): 58 with clinical diagnosis and 260 with detectable antibodies. Of these PWH, 304 completed symptom questionnaires: 121 (40%) reported symptoms, but 183 (60%) were asymptomatic. PWH with asymptomatic SARS-CoV-2 infection were more likely to be from low-income or middle-income regions, of Black or African American race, older in age, and with higher atherosclerotic cardiovascular disease risk score. Symptomatic COVID was more common with obesity, metabolic syndrome, and low HDL levels. CD4 counts and HIV viral suppression rates were similar among PWH with symptomatic vs. asymptomatic COVID.Conclusions: Asymptomatic SARS-CoV-2 infection is common among antiretroviral therapy-treated PWH globally. We determined that 60% of infections in PWH were asymptomatic. HIV clinicians must remain vigilant about COVID-19 testing among PWH to identify asymptomatic cases.

Non-neutralizing antibodies: Deleterious or propitious during SARS-CoV-2 infection?

“…Epidemiological studies have shown the presence of pre-existing antibodies cross-reactive with SARS-CoV-2 in the serum of sub-Saharan African patients. This presence has been related to a lower COVID-19 morbidity/mortality in this populations [42] , [43] . Plasmodium and human immunodeficiency virus (HIV), both microorganisms being endemic in Africa, have been shown to induce in patients nNAbs that can cross-react with SARS-CoV-2, but these antibodies do not correlate with more severe forms of COVID-19 disease [44] , [45] , [46] .…”

Humoral Response after Two Doses of BNT162b2 mRNA Vaccine Has a Role in Predicting Response after Three Doses That Is Related to Plasma HIV Viremia and Nadir CD4+ Cell Count in HIV-Positive Patients

“…Unfortunately, patients with asymptomatic infection have low SARS-CoV-2 N antibody titers [ 40 ] and a possible infection occurring early in the pandemic could not be identified even in case of antibody testing. Furthermore, asymptomatic SARS-CoV-2 infection is common in patients with HIV infection [ 41 ] and it is possible that previously infected subjects were included, despite the criteria we applied to select only SARS-CoV-2 infection naïve individuals. Summing up, there could be uncertainty about whether natural infection could impact on IgG response at our study time points.…”

Incidence and severity prediction score of COVID-19 in people living with HIV (SCOVHIV): experience from the first and second waves of the pandemic in Indonesia

“…Most of the COVID-19 cases observed in this study had no symptoms or mild symptoms (86.3%). Rial-Crestelo et al also observed a high proportion of patients with asymptomatic or mild disease in Spain (75.3% of 158 patients) [ 14 ], while a study in China showed 60% of 2464 PLHIV with COVID-19 infection being asymptomatic [ 16 ]. The proportion of severe and critical cases was smaller in our study (6.7%), which showed different patterns, although with limited numbers of COVID-19 cases in PLHIV.…”