HIV and SARS-CoV-2 infection in postpartum Kenyan women and their infants

Abstract

Background: HIV may increase SARS-CoV-2 infection risk and COVID-19 severity generally, but data are limited about its impact on postpartum women and their infants. As such, we characterized SARS-CoV-2 infection among mother-infant pairs in Nairobi, Kenya. Methods: We conducted a nested study of 53 HIV-uninfected and 51 healthy women living with HIV, as well as their HIV-exposed uninfected (N=41) and HIV-unexposed (N=48) infants, participating in a prospective cohort. SARS-CoV-2 serology was performed on plasma collected between 1 May-31 December 2020 to determine the incidence, risk factors, and symptoms of infection. SARS-CoV-2 RNA PCR and sequencing was also performed on stool samples from seropositive participants. Results: SARS-CoV-2 seropositivity was found in 38% of the 104 mothers and in 17% of the 89 infants. There was no significant association between SARS-CoV-2 infection and maternal HIV (Hazard Ratio [HR]=1.51, 95% CI: 0.780-2.94) or infant HIV exposure (HR=1.48, 95% CI: 0.537-4.09). Maternal SARS-CoV-2 was associated with a >10-fold increased risk of infant infection (HR=10.3, 95% CI: 2.89-36.8). Twenty percent of participants had symptoms, but no participant experienced severe COVID-19 or death. Seroreversion occurred in ~30% of mothers and infants. SARS-CoV-2 sequences obtained from stool were related to contemporaneously circulating variants. Conclusions: These data indicate that postpartum Kenyan women and their infants were at high risk for SARS-CoV-2 infection in 2020, and that antibody responses waned rapidly. However, most cases were asymptomatic and healthy women living with HIV did not have a substantially increased risk of infection or severe COVID-19.

Distinct Antibody Responses to Endemic Coronaviruses Pre- and Post-SARS-CoV-2 Infection in Kenyan Infants and Mothers

“…Longitudinal plasma samples collected from an ongoing study of mother-to-child virome transmission in Nairobi, Kenya (the Linda Kizazi cohort) were previously tested for SARS-CoV-2 nucleocapsid seroconversion by enzyme-linked immunosorbent assay (ELISA) [ 22 ]. The mothers and infants were grouped as either seroconverters or never-seropositive for SARS-CoV-2 during the follow-up and included in this sub-study (from April 2019 to December 2020; Figure 1 A,B and Figure S1 ).…”

“…A subset of mothers and infants in Nairobi, Kenya that were already enrolled in the Linda Kizazi Study, a prospective cohort study of mother-to-child virome transmission, consented to SARS-CoV-2 serology testing as previously described [ 22 ]. Mother–infant pairs attended clinic visits approximately every 3 months, at which time clinical data were collected, including recent diagnoses and healthcare visits, symptoms of illness at the time of the visit or since the last visit, and the history of current or recent medications or immunizations.…”

“…Plasma samples collected between April 2019 and December 2020 were selected for this sub-study based on previous SARS-CoV-2 serology testing [ 22 ]. Notably, this study period was prior to the initiation of vaccination campaigns in Kenya and spans a timeframe in which the B.1 lineage of SARS-CoV-2, which includes the D614G mutation, was found to be globally predominant [ 22 ].…”

“…Plasma samples collected between April 2019 and December 2020 were selected for this sub-study based on previous SARS-CoV-2 serology testing [ 22 ]. Notably, this study period was prior to the initiation of vaccination campaigns in Kenya and spans a timeframe in which the B.1 lineage of SARS-CoV-2, which includes the D614G mutation, was found to be globally predominant [ 22 ]. For the participants who seroconverted during the study period, up to 3 longitudinal plasma samples were included: the “first seropositive” was the plasma sample in which SARS-CoV-2 antibodies were first detected by ELISA testing [ 22 ], the “last negative” was the most recent plasma sample collected prior to the first seropositive sample time point, and a “pre-pandemic” sample (if available) was the most recent sample collected prior to October 2019 to ensure no possible exposure to SARS-CoV-2.…”

“…Notably, this study period was prior to the initiation of vaccination campaigns in Kenya and spans a timeframe in which the B.1 lineage of SARS-CoV-2, which includes the D614G mutation, was found to be globally predominant [ 22 ]. For the participants who seroconverted during the study period, up to 3 longitudinal plasma samples were included: the “first seropositive” was the plasma sample in which SARS-CoV-2 antibodies were first detected by ELISA testing [ 22 ], the “last negative” was the most recent plasma sample collected prior to the first seropositive sample time point, and a “pre-pandemic” sample (if available) was the most recent sample collected prior to October 2019 to ensure no possible exposure to SARS-CoV-2. Samples from participants that did not seroconvert to SARS-CoV-2 during the study period include up to 2 longitudinal plasma samples: a “time-matched seronegative” sample, which was collected during the time window of the last negative sample from the seroconverters (December 2019–April 2020); and a “pre-pandemic” sample as described above.…”