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Observational Study
. 2023 Feb 8;76(3):e71-e81.
doi: 10.1093/cid/ciac640.

Household Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 From Adult Index Cases With and Without Human Immunodeficiency Virus in South Africa, 2020-2021: A Case-Ascertained, Prospective, Observational Household Transmission Study

Jackie Kleynhans  1   2 , Sibongile Walaza  1   2 , Neil A Martinson  3   4 , Mzimasi Neti  1 , Anne von Gottberg  1   5 , Jinal N Bhiman  1   5 , Dylan Toi  1 , Daniel G Amoako  1   6 , Amelia Buys  1 , Kedibone Ndlangisa  1 , Nicole Wolter  1   5 , Leisha Genade  3 , Lucia Maloma  3 , Juanita Chewparsad  3 , Limakatso Lebina  3   7 , Linda de Gouveia  1 , Retshidisitswe Kotane  1 , Stefano Tempia  1   2 , Cheryl Cohen  1   2
Affiliations
Observational Study

Household Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 From Adult Index Cases With and Without Human Immunodeficiency Virus in South Africa, 2020-2021: A Case-Ascertained, Prospective, Observational Household Transmission Study

Jackie Kleynhans et al. Clin Infect Dis. .

Abstract

Background: In South Africa, 19% of adults are living with human immunodeficiency virus (HIV; LWH). Few data on the influence of HIV on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) household transmission are available.

Methods: We performed a case-ascertained, prospective household transmission study of symptomatic adult index SARS-CoV-2 cases LWH and not living with HIV (NLWH) and their contacts from October 2020 to September 2021. Households were followed up 3 times a week for 6 weeks to collect nasal swabs for SARS-CoV-2 testing. We estimated household cumulative infection risk (HCIR) and duration of SARS-CoV-2 positivity (at a cycle threshold value <30 as proxy for high viral load).

Results: HCIR was 59% (220 of 373), not differing by index HIV status (60% LWH vs 58% NLWH). HCIR increased with index case age (35-59 years: adjusted OR [aOR], 3.4; 95% CI, 1.5-7.8 and ≥60 years: aOR, 3.1; 95% CI, 1.0-10.1) compared with 18-34 years and with contacts' age, 13-17 years (aOR, 7.1; 95% CI, 1.5-33.9) and 18-34 years (aOR, 4.4; 95% CI, 1.0-18.4) compared with <5 years. Mean positivity was longer in cases LWH (adjusted hazard ratio, 0.4; 95% CI, .1-.9).

Conclusions: Index HIV status was not associated with higher HCIR, but cases LWH had longer positivity duration. Adults aged >35 years were more likely to transmit and individuals aged 13-34 to be infected SARS-CoV-2 in the household. As HIV infection may increase transmission, health services must maintain HIV testing and antiretroviral therapy initiation.

Keywords: COVID-19; HIV; SARS-CoV-2; acquisition; transmission.

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Conflict of interest statement

Potential conflicts of interest. C. C. has received grant support from Sanofi Pasteur, the CDC, Wellcome Trust, Programme for Applied Technologies in Health, Bill & Melinda Gates Foundation, and South African Medical Research Council. N. W., A. v. G., J. K., and S. W. report receiving grant funds paid to institution from Sanofi Pasteur and the Bill & Melinda Gates Foundation. A. v. G. also reports an unpaid position as chairperson of the National Advisory Group on Immunisation. L. L. reports receiving grant funds from the CDC and Bill & Melinda Gates Foundation. N. M. reports receiving grant funds paid to institution from Pfizer to conduct observational studies on the burden of pneumonia in South Africa; unpaid participation on a data and safety monitoring board of a tuberculosis (TB) host-directed therapies trial and a scientific advisory board on a trial of an electronic reminder to take daily TB treatment; and an unpaid leadership or fiduciary role with the Setshaba Research Center. S. W. reports an unpaid leadership or fiduciary role for a board, society, committee, or advocacy group. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Adult SARS-CoV-2 index cases and household contacts enrolled, Klerksdorp and Soweto, South Africa, 2020–2021. Abbreviations: PCR, polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
Figure 2.
Figure 2.
Factors associated with severe acute respiratory syndrome coronavirus 2 household transmission in index cases and acquisition in household contacts on multivariable logistic regression, Klerksdorp and Soweto, South Africa, 2020–2021 (n = 373). Abbreviation: HIV, human immunodeficiency virus.
Figure 3.
Figure 3.
Severe acute respiratory syndrome coronavirus 2 episode duration in index cases living with and not living with HIV, Klerksdorp and Soweto, South Africa, 2020–2021 (n = 123). Excludes those positive at last specimen collected. Abbreviation: HIV, human immunodeficiency virus.
Figure 4.
Figure 4.
Factors associated with severe acute respiratory syndrome coronavirus 2 episode duration irrespective of Ct value (left), Ct <30 (right) in index cases on Weibull accelerated failure time regression, Klerksdorp and Soweto, South Africa, 2020–2021 (n = 123). Abbreviations: BMI, body mass index; Ct, cycle threshold; HIV, human immunodeficiency virus.
Figure 5.
Figure 5.
Interval between onset of symptoms in the index case and onset of symptoms in household contacts with severe acute respiratory syndrome coronavirus 2 (serial interval) by HIV status of the index case, Klerksdorp and Soweto, South Africa, 2020–2021 (n = 69). Arrow indicates cutoff for inclusion in analysis for factors associated with serial interval duration. Abbreviations: BMI, body mass index; Ct, cycle threshold; HIV, human immunodeficiency virus.
Figure 6.
Figure 6.
Factors associated with serial interval of severe acute respiratory syndrome coronavirus 2 in cases with symptomatic illness on Weibull accelerated failure time regression, Klerksdorp and Soweto, South Africa, 2020–2021 (n = 62). Abbreviation: HIV, human immunodeficiency virus.
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