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.

Keywords: ART; COVID-19; HIV; PLWH; SARS-CoV-2; South Africa; viral load.

Figure 1

Seroprevalence of SARS-CoV-2 in patient cohort (n = 150): (A) Detection of SARS-CoV-2 RBD- and S1-specific IgG antibodies in the study participants’ plasma. A total of thirty pre-pandemic patient samples [22] served as control. Results are represented by the OD units of each isotype, adjusted to the cut-off value of each individual plate and then normalized to the cut-off, which was set as one (indicated by the dotted line). The cut-off was determined by the mean OD + 2SD of the pre-pandemic samples; (B) The correlation between IgG responses to SARS-CoV-2 RBD and S1 antigens. Statistical analyses were performed using a non-parametric Spearman Rank correlation; (C) Timeline of SARS-CoV-2 IgG antibody detection per month over the course of the recruitment period from October 2020 to June 2021. Data is represented as a percentage (positive or negative) for the patient cohort. The total number of patients is indicated above the bars. A patient was considered to be positive for SARS-CoV-2 infection if either RBD or S1 responses were above our calculated cut-off values for the IgG antibody.

Figure 2

Distribution of HIV VL in SARS-CoV2 seropositive and negative patients. The dotted line indicates the threshold (HIV VL = 1000 copies/mL) used for determining uncontrolled HIV viremia.