Prolonged Shedding of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at High Viral Loads Among Hospitalized Immunocompromised Persons Living With Human Immunodeficiency Virus (HIV), South Africa. (2nd February 2022)

• Record Type: Journal Article
• Authors: Meiring, Susan; Tempia, Stefano; Bhiman, Jinal N; Buys, Amelia; Kleynhans, Jackie; Makhasi, Mvuyo; McMorrow, Meredith; Moyes, Jocelyn; Quan, Vanessa; Walaza, Sibongile; du Plessis, Mignon; Wolter, Nicole; von Gottberg, Anne; Cohen, Cheryl
• Is Part Of: Clinical infectious diseases. Volume 75:Number 1(2022)
• Page Start: e144
• Page End: e156
• Publication Date: 2022-02-02
• Subjects: COVID-19 -- HIV -- immunocompromised -- respiratory virus -- shedding duration; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciac077
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: We assessed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA shedding duration and magnitude among persons living with human immunodeficiency virus (HIV, PLHIV). Methods: From May through December 2020, we conducted a prospective cohort study at 20 hospitals in South Africa. Adults hospitalized with symptomatic coronavirus disease 2019 (COVID-19) were enrolled and followed every 2 days with nasopharyngeal/oropharyngeal (NP/OP) swabs until documentation of cessation of SARS-CoV-2 shedding (2 consecutive negative NP/OP swabs). Real-time reverse transcription-polymerase chain reaction testing for SARS-CoV-2 was performed, and cycle-threshold (Ct) values < 30 were considered a proxy for high SARS-CoV-2 viral load. Factors associated with prolonged shedding were assessed using accelerated time-failure Weibull regression models. Results: Of 2175 COVID-19 patients screened, 300 were enrolled, and 257 individuals (155 HIV-uninfected and 102 PLHIV) had > 1 swabbing visit (median 5 visits [range 2–21]). Median time to cessation of shedding was 13 days (interquartile range [IQR] 6–25) and did not differ significantly by HIV infection. Among a subset of 94 patients (41 PLHIV and 53 HIV-uninfected) with initial respiratory sample Ct -value < 30, median time of shedding at high SARS-CoV-2 viral load was 8 days (IQR 4–17). This was significantly longer in PLHIV with CD4 count < 200 cells/µL, compared to HIV-uninfected persons (median 27 days [IQR 8–43] vs 7 days [IQR 4–13]; adjusted hazard ratio [aHR] 0.14, 95% confidence interval [CI] .07–.28, P < .001), as well as in unsuppressed-HIV versus HIV-uninfected persons. Conclusions: Although SARS-CoV-2 shedding duration did not differ significantly by HIV infection, among a subset with high initial SARS-CoV-2 viral loads, immunocompromised PLHIV shed SARS-CoV-2 at high viral loads for longer than HIV-uninfected persons. Better HIV control may potentially decrease transmission time of SARS-CoV-2. Abstract : Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shedding duration did not significantly differ by human immunodeficiency virus (HIV) infection. Among a subset of persons with high initial SARS-CoV-2 viral load, immunocompromised persons living with HIV shed SARS-CoV-2 at higher viral loads for a longer duration, potentially increasing their transmission period.