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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

2022; Oxford University Press; Volume: 75; Issue: 1 Linguagem: Inglês

10.1093/cid/ciac077

1537-6591

Susan Meiring, Stefano Tempia, Jinal N. Bhiman, Amelia Buys, Jackie Kleynhans, Mvuyo Makhasi, Meredith McMorrow, Jocelyn Moyes, Vanessa Quan, Sibongile Walaza, Mignon du Plessis, Nicole Wolter, Anne von Gottberg, Cheryl Cohen, John L. Black, Dominique Goedhals, Bonnie Maloba, Samantha Potgieter, Marianne Black, Vindana Chibabhai, Nonhlanhla Mbenenge, Trusha Nana, Sarah Stacey, Florette K. Treurnicht, Masego Moncho, Maphoshane Nchabeleng, Grace Shikwambane-Ntlemo, Rispah Chomba, Jeremy Nel, A A Hoosen, Mohamed Said, Junaid Bayat, Lisha Sookan, Surendra Sirkar, Halima Dawood, Sumayya Haffejee, S Pillay, Praksha Ramjathan, Nomonde R. Mvelase, Javid Mulla, Ruth Lekalakala, Matamela Madua, Sindile Ntuli, Thomas Crede, Kessendri Reddy, Jantjie Taljaard, Andrew Whitelaw,

COVID-19 epidemiological studies

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.