HIV status is not associated with SARS-CoV-2 viral load and longer duration of infection among people with well-controlled HIV and high COVID-19 vaccine coverage

Abstract

Background: HIV may alter SARS-CoV-2 viral load and increase the duration of SARS-CoV-2 infection and, thereby, drive the emergence of variants of concern. This study investigated the association between HIV with SARS-CoV-2 viral load and duration of infection in Botswana, in the era of high antiretroviral therapy (ART) coverage.

Methods: This cohort study was conducted in Gaborone, Botswana, covering 6 healthcare facilities. Gaborone residents with confirmed SARS-CoV-2 infection were recruited through active screening, passive diagnosis, and contact tracing. Among enrolled participants, we conducted weekly serial testing for SARS-CoV2. The primary outcomes for this analysis were SARS-CoV-2 viral load and duration of SARS-CoV-2 infection. SARS-CoV-2 viral load was measured using RT-PCR cycle threshold (Ct) value at the time of diagnosis with higher Ct value indicating a lower viral load. Duration of SARS-CoV-2 infection was calculated as the number of days between symptom onset and date of negative PCR test. Multiple linear regression and Cox-proportional hazard models were employed to determine the association between HIV infection status and outcome variables.

Findings: Of the 578 enrolled participants, 486 (84.1%) with known HIV status were included in the analysis. Of the population, 69.3% were female, mean age was 37.8 years, and 88.7% were vaccinated for COVID-19. People living with HIV (PLWH) accounted for 26.1% of the population, with a mean CD4+ T cell count of 715 cells/μL. Among PLWH, 86.6% were taking ARTs at the time of diagnosis. The mean Ct value across all participants was 22.5 (SD: 6.16). No significant difference in Ct values was observed between HIV and CD4+ T cell categories. A significant association was found between age and Ct values (β = -0.05, 95% CI: -0.11, 0.00, p = 0.03). Survival analysis showed increased time to negative COVID-19 PCR for PLWH with CD4+ T cell count ≥ 500 cells/μL (HR = 1.45, 95% CI: 1.02, 2.05, p = 0.03) compared to people without HIV, but not for PLWH CD4+ T cell count < 500 cells/μL (HR = 1.01, 95% CI: 0.62, 1.65, p = 0.9).

Interpretation: Among PLWH with well-controlled HIV disease and high vaccine coverage, we found no evidence of an association between HIV status with SARS-CoV-2 viral load or increased duration of SARS-CoV-2 infection. Additional research is needed to confirm shorter duration of SARS-CoV-2 infection among PLWH with CD4+ T cell counts ≥ 500 cells/μL.

Source of funding: This research was supported by US NIH grant #R01AI170204.

Keywords: CD4 cell count; COVID-19; HIV/AIDS; Human Immunodeficiency Virus; SARS-CoV-2; chronic infection; cycle threshold value; immunosuppression; transmission; viral shedding.

Figure 1.

Boxplot showing the comparison of CT values across HIV-negative individuals and HIV-positive individuals by CD4 count categories (<500, 500–999, and ≥1000 cells/μL). The median CT values are similar across groups (P = 0.91).

Figure 2.

Scatter plot showing the relationship between CT values and CD4 cell counts (cells/μL).The blue line represents the linear regression line, with a correlation coefficient (R) of −0.038 and a p-value of 0.76.

Figure 3.

Kaplan-Meier Survival Curves comparing time-to-event outcomes between HIV with CD4 category.