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. 2022 Aug 24;75(1):e144-e156.
doi: 10.1093/cid/ciac077.

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

Susan Meiring  1   2 , Stefano Tempia  3   4   2 , Jinal N Bhiman  3   5 , Amelia Buys  3 , Jackie Kleynhans  3   2 , Mvuyo Makhasi  3 , Meredith McMorrow  4   6 , Jocelyn Moyes  3 , Vanessa Quan  1 , Sibongile Walaza  3   2 , Mignon du Plessis  3   5 , Nicole Wolter  3   5 , Anne von Gottberg  3   5 , Cheryl Cohen  3   2 ; COVID-19 shedding study group
Collaborators, Affiliations

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

Susan Meiring et al. Clin Infect Dis. .

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.

Keywords: COVID-19; HIV; immunocompromised; respiratory virus; shedding duration.

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Figures

Figure 1.
Figure 1.
Flow diagram of hospitalized SARS-CoV-2-infected patients screened and enrolled. Abbreviations: HIV, human immunodeficiency virus; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
Figure 2.
Figure 2.
Kaplan-Meier plots of proportion of SARS-CoV-2 shedding by days following symptom onset by (A) HIV status, (B) presence of obesity (BMI > 30), (C) HIV viral load among PLHIV, and (D). CD4 T-lymphocyte count among persons living with HIV (PLHIV). Abbreviations: BMI, body mass index; HIV, human immunodeficiency virus; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
Figure 3.
Figure 3.
Kaplan-Meier plots of proportion of high viral load SARS-CoV-2 shedding by days following symptom onset by (A) HIV status and (B) HIV viral load in persons living with HIV. Abbreviations: HIV, human immunodeficiency virus; SARS-Cov-2, severe acute respiratory syndrome coronavirus 2.
Figure 4.
Figure 4.
Spike protein antibody binding by HIV status by day 7, 14 and 21, post symptom onset amongst hospitalized SARS-CoV-2-infected participants (n = 201). Abbreviations: HIV, human immunodeficiency virus; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
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