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

Abstract

Background

We assessed SARS-CoV-2 RNA shedding duration and magnitude amongst persons living with HIV (PLHIV).

Methods

From May through December 2020, we conducted a prospective cohort study at 20 hospitals in South Africa. Adults hospitalised with symptomatic COVID-19 were enrolled and followed every two days with nasopharyngeal/oropharyngeal (NP/OP) swabs until documentation of cessation of SARS-CoV-2 shedding (two consecutive negative NP/OP swabs). Real-time reverse transcription-polymerase chain reaction testing for SARS-CoV-2 was performed and Cycle-threshold (C _t) 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 2,175 COVID-19 patients screened, 300 were enrolled and 257 individuals (155 HIV-uninfected and 102 PLHIV) had >1 swabbing visit (median 5 visits (range2-21)). Median time to cessation of shedding was 13 days (inter-quartile range (IQR)6-25) and did not differ significantly by HIV-infection.

Discussion

Amongst a subset of 94 patients (41 PLHIV and 53 HIV-uninfected) with initial respiratory sample C _t-value <30, median time of shedding at high SARS-CoV-2 viral load was 8 days (IQR4-17). This was significantly longer in PLHIV with CD4 count<200cells/µl, compared to HIV-uninfected persons (median 27 days (IQR8-43) versus 7 days (IQR 4-13); aHR 0.14, 95%CI 0.07-0.28, p<0.001), with similar results in unsuppressed-HIV versus HIV-uninfected persons.

Conclusion

Although SARS-CoV-2 shedding duration did not differ significantly by HIV-infection, amongst 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.