Prolonged shedding of SARS-CoV-2 at high viral load amongst hospitalised immunocompromised persons living with HIV in South Africa

Abstract

Purpose: There is limited information on SARS-CoV-2 shedding duration amongst persons living with HIV (PLWH). We hypothesised that PLWH shed SARS-CoV-2 for longer periods and at higher viral load than HIV-uninfected persons. Methods & Materials: From May through December 2020, we conducted a prospective cohort study at 17 hospitals in South Africa. Patients aged >18 years hospitalised with symptomatic COVID-19 were enrolled and followed up every two days with nasopharyngeal/oropharyngeal (NP/OP) swabs until cessation of SARS-CoV-2 shedding (two consecutive negative NP/OP swabs). Real-time reverse transcription polymerase chain reaction (rRT-PCR) testing for SARS-CoV-2 was performed and Cycle-threshold (Ct) values 1 swabbing visit (median visits 5 (range 2-21)). Median time to cessation of shedding was 13 days (inter-quartile range (IQR) 6-25) and did not differ by HIV status. Among PLWH, when adjusting for CD4 count and obesity, those not currently taking antiretroviral therapy were more likely to have prolonged SARS-CoV-2 shedding (median 13 days (IQR 6-37) vs 10 days (IQR 4-22) on antiretroviral therapy, adjusted hazard ratio (aHR) 0.03, 95% confidence interval (CI) 0.002-0.38, p=0.007).Amongst a subset of 94 patients with initial respiratory sample Ct values 200 cells/μl shed at high SARS-CoV-2 viral loads for a similar time period (median 7 days, IQR 4-10, aHR 1.14, 95% CI 0.56-2.31, p=0.713), compared to HIV-uninfected persons (median 7 days, IQR 4-13). Conclusion: PLWH not on treatment or with CD4 cell count<200 shed SARS-CoV-2 for a longer duration and at a higher SARS-CoV-2 viral load than HIV-uninfected persons. Better HIV control may facilitate quicker clearance of SARS-CoV-2.