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
Author:
Meiring Susan12, Tempia Stefano342, Bhiman Jinal N35, Buys Amelia3, Kleynhans Jackie32, Makhasi Mvuyo3, McMorrow Meredith46, Moyes Jocelyn3, Quan Vanessa1, Walaza Sibongile32, du Plessis Mignon35, Wolter Nicole35, von Gottberg Anne35, Cohen Cheryl32, Black John, Goedhals Dominique, Maloba Bonnie, Potgieter Samantha, Black Marianne, Chibabhai Vindana, Mbenenge Nonhlanhla, Nana Trusha, Stacey Sarah, Treurnicht Florette, Moncho Masego, Nchabeleng Maphoshane, Shikwambane-Ntlemo Grace, Chomba Rispah, Nel Jeremy, Hoosen Anwar, Said Mohamed, Bayat Junaid, Sookan Lisha, Sirkar Surendra, Dawood Halima, Haffejee Sumayya, Pillay Somasundram, Ramjathan Praksha, Mvelase Nomonde, Mulla Javid, Lekalakala-Mokaba Ruth, Madua Matamela, Ntuli Sindile, Crede Thomas, Reddy Kessendri, Taljaard Jantjie, Whitelaw Andrew,
Affiliation:
1. Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service , Johannesburg , South Africa 2. School of Public Health, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg , South Africa 3. Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service , Johannesburg , South Africa 4. Influenza Division, Centers for Disease Control and Prevention , Atlanta, Georgia , USA 5. School of Pathology, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg , South Africa 6. Division of Viral Diseases, US Centers for Disease Control and Prevention , Atlanta, Georgia , USA
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.
Funder
Wellcome Trust US Centers for Disease Control and Prevention
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Microbiology (medical)
Cited by
39 articles.
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