TY - JOUR
T1 - 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
AU - COVID-19 shedding study group
AU - Meiring, Susan
AU - Tempia, Stefano
AU - Bhiman, Jinal N.
AU - Buys, Amelia
AU - Kleynhans, Jackie
AU - Makhasi, Mvuyo
AU - McMorrow, Meredith
AU - Moyes, Jocelyn
AU - Quan, Vanessa
AU - Walaza, Sibongile
AU - Du Plessis, Mignon
AU - Wolter, Nicole
AU - Von Gottberg, Anne
AU - Cohen, Cheryl
AU - Black, John
AU - Goedhals, Dominique
AU - Maloba, Bonnie
AU - Potgieter, Samantha
AU - Black, Marianne
AU - Chibabhai, Vindana
AU - Mbenenge, Nonhlanhla
AU - Nana, Trusha
AU - Stacey, Sarah
AU - Treurnicht, Florette
AU - Moncho, Masego
AU - Nchabeleng, Maphoshane
AU - Shikwambane-Ntlemo, Grace
AU - Chomba, Rispah
AU - Nel, Jeremy
AU - Hoosen, Anwar
AU - Said, Mohamed
AU - Bayat, Junaid
AU - Sookan, Lisha
AU - Sirkar, Surendra
AU - Dawood, Halima
AU - Haffejee, Sumayya
AU - Pillay, Somasundram
AU - Ramjathan, Praksha
AU - Mvelase, Nomonde
AU - Mulla, Javid
AU - Lekalakala-Mokaba, Ruth
AU - Madua, Matamela
AU - Ntuli, Sindile
AU - Crede, Thomas
AU - Reddy, Kessendri
AU - Taljaard, Jantjie
AU - Whitelaw, Andrew
N1 - Funding Information:
The study was funded by the Wellcome Trust (grant number 221003/Z/20/Z) in collaboration with the Foreign, Commonwealth and Development Office, United Kingdom; the US Centers for Disease Control and Prevention (co-operative agreement number: 6 U01IP001048-04-02), as well as the National Institute for Communicable Diseases, a divi sion of the National Health Laboratory Service, South Africa. The funding agencies had no role in the development of the study protocol, data col lection, analysis and interpretation, writing of the report, or decision to submit.
Publisher Copyright:
© 2022 The Author(s).
PY - 2022/7/1
Y1 - 2022/7/1
N2 - 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.
AB - 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.
KW - COVID-19
KW - HIV
KW - immunocompromised
KW - respiratory virus
KW - shedding duration
UR - http://www.scopus.com/inward/record.url?scp=85137124311&partnerID=8YFLogxK
U2 - 10.1093/cid/ciac077
DO - 10.1093/cid/ciac077
M3 - Article
C2 - 35134129
AN - SCOPUS:85137124311
VL - 75
SP - E144-E156
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
SN - 1058-4838
IS - 1
ER -