SARS-CoV-2 seroprevalence, and IgG concentration and pseudovirus neutralising antibody titres after infection, compared by HIV status: a matched case-control observational study

Abstract

Background: Most cohorts show similar or lower COVID-19 incidence among people living with HIV compared with the general population. However, incidence might be affected by lower testing rates among vulnerable populations. We aimed to compare SARS-CoV-2 IgG seroprevalence, disease severity, and neutralising antibody activity after infection among people with and without HIV receiving care in a county hospital system over a 3-month period.

Methods: In this matched case-control observational study, remnant serum samples were collected between Aug 1 and Oct 31, 2020, from all people living with HIV who underwent routine outpatient laboratory testing in a municipal health-care system (San Francisco General Hospital, CA, USA). Samples from people living with HIV were date of collection-matched (same day) and age-matched (±5 years) to samples from randomly selected adults (aged 18 years or older) without HIV receiving care for chronic conditions at the same hospital. We compared seroprevalence by HIV status via mixed-effects logistic regression models, accounting for the matched structure of the data (random effects for the matched group), adjusting for age, sex, race or ethnicity, and clinical factors (ie, history of cardiovascular or pulmonary disease, and type 2 diabetes). Severe COVID-19 was assessed in participants with past SARS-CoV-2 (IgG or PCR) infection by chart review and compared with multivariable mixed-effects logistic regression, adjusting for age and sex. SARS-CoV-2 IgG, neutralising antibody titres, and antibody avidity were measured in serum of participants with previous positive PCR tests and compared with multivariable mixed-effects models, adjusting for age, sex, and time since PCR-confirmed SARS-CoV-2 infection.

Findings: 1138 samples from 955 people living with HIV and 1118 samples from 1062 people without HIV were tested. SARS-CoV-2 IgG seroprevalence was 3·7% (95% CI 2·4 to 5·0) among people with HIV compared with 7·4% (5·7 to 9·2) among people without HIV (adjusted odds ratio 0·50, 95% CI 0·30 to 0·83). Among 31 people with HIV and 70 people without HIV who had evidence of past infection, the odds of severe COVID-19 were 5·52 (95% CI 1·01 to 64·48) times higher among people living with HIV. Adjusting for time since PCR-confirmed infection, SARS-CoV-2 IgG concentrations were lower (percentage change -53%, 95% CI -4 to -76), pseudovirus neutralising antibody titres were lower (-67%, -25 to -86), and avidity was similar (7%, -73 to 87) among people living with HIV compared with those without HIV.

Interpretation: Although fewer infections were detected by SARS-CoV-2 IgG testing among people living with HIV than among those without HIV, people with HIV had more cases of severe COVID-19. Among people living with HIV with past SARS-CoV-2 infection, lower IgG concentrations and pseudovirus neutralising antibody titres might reflect a diminished serological response to infection, and the similar avidity could be driven by similar time since infection.

Funding: US National Institute of Allergy and Infectious Diseases, US National Institutes of Health.

Figure 1

Flow diagram of matching process for participants and specimens enrolled in the study

Figure 2

SARS-CoV-2 IgG concentrations compared between people living with HIV (n=31) and people without HIV (n=70) The thick bars indicate the mean, and error bars indicate the SE. The relative mean was 42% (95% CI −16 to −59) lower in people with HIV than in those without HIV (adjusted for time since PCR-confirmed infection: −53%, 95% CI −4 to −76). Relative mean was calculated by log transforming IgG concentrations and then using mixed-effects linear regression adjusting for age, sex, and HIV status, with an indicator for the matched group included as a random effect. The same process was repeated with the inclusion of a variable for days since the date of PCR positivity for the 48 (48%) of 101 participants who had received a previous positive PCR test. RFU=relative fluorescent unit.

Figure 3

SARS-CoV-2 IgG pseudovirus neutralising antibody titres compared between people living with HIV (n=31) and people without HIV (n=70) The thick bars indicate the mean, and error bars indicate the SE. The relative mean was 53% (95% CI −1 to −78) lower in people with HIV than in those without HIV (adjusted for time since PCR-confirmed infection: −67%, 95% CI −25 to −86). Relative mean was calculated by log transforming IgG concentrations and then using mixed-effects interval regression adjusting for age, sex, and HIV status, with an indicator for the matched group included as a random effect. The same process was repeated with the inclusion of a variable for days since infection based on the date of PCR positivity for the 48 (48%) of 101 participants who had received a previous positive PCR test.

Figure 4

SARS-CoV-2 IgG percentage antibody avidity compared between people living with HIV (n=31) and people without HIV (n=70) The thick bars indicate the mean, and error bars indicate the SE. The relative mean was 10% (95% CI −28 to 48) higher in people with HIV than in those without HIV (adjusted for time since PCR-confirmed infection: 7%, 95% CI −73 to 87). Relative mean was calculated using a mixed-effects generalised linear model from the binomial distribution adjusting for age, sex, and HIV status, with an indicator for the matched group included as a random effect. The same process was repeated with the inclusion of a variable for days since infection based on the date of PCR positivity for the 48 (48%) of 101 participants who had received a previous positive PCR test.