Prevalence and factors associated with SARS-CoV-2 seropositivity in the Spanish HIV Research Network Cohort

Abstract

Objectives: We aimed to assess the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and factors associated with seropositivity and asymptomatic coronavirus disease 2019 (COVID-19) among people with HIV (PWH).

Methods: This was a cross-sectional study carried out within the cohort of the Spanish HIV Research Network. Participants were consecutive PWH with plasma collected from 1st April to 30th September 2020. We determined SARS-CoV-2 antibodies (Abs) in plasma. Illness severity (NIH criteria) was assessed by a review of medical records and, if needed, participant interviews. Multivariable logistic regression analysis was used to identify predictors of seropositivity among the following variables: sex, age, country of birth, education level, comorbidities (hypertension, chronic heart disease, diabetes mellitus, non-AIDS-related cancer, chronic kidney disease, cirrhosis), route of HIV acquisition, prior AIDS, CD4+ cell count, HIV viral load, nucleoside/nucleotide reverse transcriptase inhibitor (N [t]RTI) backbone, type of third antiretroviral drug, and month of sample collection.

Results: Of 1076 PWH (88.0% males, median age 43 years, 97.7% on antiretroviral therapy, median CD4+ 688 cells/mm³, 91.4% undetectable HIV viral load), SARS-CoV-2 Abs were detected in 91 PWH, a seroprevalence of 8.5% (95%CI 6.9-10.3%). Forty-five infections (45.0%) were asymptomatic. Variables independently associated with SARS-CoV-2 seropositivity were birth in Latin American countries versus Spain (adjusted odds ratio (aOR) 2.30, 95%CI 1.41-3.76, p 0.001), and therapy with tenofovir disoproxil fumarate plus emtricitabine (TDF/FTC) versus tenofovir alafenamide (TAF)/FTC as the N(t)RTI backbone (aOR 0.49, 95%CI 0.26-0.94, p 0.031).

Conclusions: Many SARS-CoV-2 infections among PWH were asymptomatic, and birth in Latin American countries increased the risk of SARS-CoV-2 seropositivity. Our analysis, adjusted by comorbidities and other variables, suggests that TDF/FTC may prevent SARS-CoV-2 infection among PWH.

Keywords: COVID-19; HIV; SARS-CoV-2; Serology; Seroprevalence.

Fig. 1

Association of the nucleoside/nucleotide reverse transcriptase inhibitors (N(t)RTI) backbone with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity by logistic regression analysis. Multivariable models were adjusted by sex, age, country of birth, education level, comorbidities, route of HIV acquisition, prior AIDS, CD4+ cell count, HIV viral load, type of third antiretroviral drug used, and month of sample collection. To avoid sparse data bias, we used penalization through data augmentation to perform multivariate logistic regression. TAF, tenofovir alafenamide; FTC, emtricitabine; TDF, tenofovir disoproxil fumarate; ABC, abacavir; 3TC, lamivudine; ART, antiretroviral therapy; OR, odds ratio; CI, confidence interval.