SARS-CoV-2 Infection Is Associated with Uncontrolled HIV Viral Load in Non-Hospitalized HIV-Infected Patients from Gugulethu, South Africa

Abstract

In South Africa, high exposure to SARS-CoV-2 occurs primarily in densely populated, low-income communities, which are additionally burdened by highly prevalent Human Immunodeficiency Virus (HIV). With the aim to assess SARS-CoV-2 seroprevalence and its association with HIV-related clinical parameters in non-hospitalized patients likely to be highly exposed to SARS-CoV-2, this observational cross-sectional study was conducted at the Gugulethu Community Health Centre Antiretroviral clinic between October 2020 and June 2021, after the first COVID-19 wave in South Africa and during the second and beginning of the third wave. A total of 150 adult (median age 39 years [range 20–65 years]) HIV-infected patients (69% female; 31% male) were recruited. 95.3% of the cohort was on antiretroviral therapy (ART), had a median CD4 count of 220 cells/µL (range 17–604 cells/µL) and a median HIV viral load (VL) of 49 copies/mL (range 1–1,050,867 copies/mL). Furthermore, 106 patients (70.7%) were SARS-CoV-2 seropositive, and 0% were vaccinated. When stratified for HIV VL, patients with uncontrolled HIV viremia (HIV VL > 1000 copies/mL) had significantly higher odds of SARS-CoV-2 seropositivity than patients with HIV VL < 1000 copies/mL, after adjusting for age, sex and ART status (p = 0.035, adjusted OR 2.961 [95% CI: 1.078–8.133]). Although the cause–effect relationship could not be determined due to the cross-sectional study design, these results point towards a higher risk of SARS-CoV-2 susceptibility among viremic HIV patients, or impaired HIV viral control due to previous co-infection with SARS-CoV-2.

Impact of Covid-19 on People Living With Hiv in Madagascar: A Sars-Cov2 Sero-Prevalence Survey

“…Although we observed a marginal significant difference in SARS-CoV-2 seroprevalence between PLHIV on HAART and those who were not, we observed no significant relation between HIV-1 viral load and SARS-CoV-2 seroprevalence, contrarily to what was reported in a study from South Africa (Lambarey et al, 2022). This discrepancy can be explained by the sample size because the report from South Africa was from 150 patients on HAART while ours was on 2,161 PLHIV on HAART.…”

Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors

“…Finally, in the context of long-term chronic infections, superinfection with SARS-CoV-2 (over a pre-existing condition) may be more likely than acquiring the other pathogen during the brief course of a COVID-19 episode. Uncontrolled HIV infection, in particular, appears to increase susceptibility to SARS-CoV-2 [ 468 ], and to promote persistent COVID-19 in some patients [ 545 ], by suppressing efficient immunity. Certain chronic coinfections predispose to NCDs as well (see Section 5.1 .…”

Immunological responses in SARS-CoV-2 and HIV co-infection versus SARS-CoV-2 mono-infection: case report of the interplay between SARS-CoV-2 and HIV

“…Despite these limitations, we still believe our study provides an insight into the interplay between HIV and SARS-CoV-2. Therefore, the subpopulation of PLWH with insufficient immune reconstitution might be more vulnerable to SARS-CoV-2 infection, the development of COVID-19 disease and its associated complications as reported by others [ 56 ]. The coexistence of both viruses in those with lower CD4 + T cell count may evolve immune escape mutations leading to adverse public health outcomes.…”