Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA.
Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA.
Lancet HIV. 2021 Jun;8(6):e334-e341. doi: 10.1016/S2352-3018(21)00072-2. Epub 2021 Apr 29.
Most cohorts show similar or lower COVID-19 incidence among people living with HIV compared with the general population. However, incidence might be affected by lower testing rates among vulnerable populations. We aimed to compare SARS-CoV-2 IgG seroprevalence, disease severity, and neutralising antibody activity after infection among people with and without HIV receiving care in a county hospital system over a 3-month period.
In this matched case-control observational study, remnant serum samples were collected between Aug 1 and Oct 31, 2020, from all people living with HIV who underwent routine outpatient laboratory testing in a municipal health-care system (San Francisco General Hospital, CA, USA). Samples from people living with HIV were date of collection-matched (same day) and age-matched (±5 years) to samples from randomly selected adults (aged 18 years or older) without HIV receiving care for chronic conditions at the same hospital. We compared seroprevalence by HIV status via mixed-effects logistic regression models, accounting for the matched structure of the data (random effects for the matched group), adjusting for age, sex, race or ethnicity, and clinical factors (ie, history of cardiovascular or pulmonary disease, and type 2 diabetes). Severe COVID-19 was assessed in participants with past SARS-CoV-2 (IgG or PCR) infection by chart review and compared with multivariable mixed-effects logistic regression, adjusting for age and sex. SARS-CoV-2 IgG, neutralising antibody titres, and antibody avidity were measured in serum of participants with previous positive PCR tests and compared with multivariable mixed-effects models, adjusting for age, sex, and time since PCR-confirmed SARS-CoV-2 infection.
1138 samples from 955 people living with HIV and 1118 samples from 1062 people without HIV were tested. SARS-CoV-2 IgG seroprevalence was 3·7% (95% CI 2·4 to 5·0) among people with HIV compared with 7·4% (5·7 to 9·2) among people without HIV (adjusted odds ratio 0·50, 95% CI 0·30 to 0·83). Among 31 people with HIV and 70 people without HIV who had evidence of past infection, the odds of severe COVID-19 were 5·52 (95% CI 1·01 to 64·48) times higher among people living with HIV. Adjusting for time since PCR-confirmed infection, SARS-CoV-2 IgG concentrations were lower (percentage change -53%, 95% CI -4 to -76), pseudovirus neutralising antibody titres were lower (-67%, -25 to -86), and avidity was similar (7%, -73 to 87) among people living with HIV compared with those without HIV.
Although fewer infections were detected by SARS-CoV-2 IgG testing among people living with HIV than among those without HIV, people with HIV had more cases of severe COVID-19. Among people living with HIV with past SARS-CoV-2 infection, lower IgG concentrations and pseudovirus neutralising antibody titres might reflect a diminished serological response to infection, and the similar avidity could be driven by similar time since infection.
US National Institute of Allergy and Infectious Diseases, US National Institutes of Health.
大多数队列研究表明，与普通人群相比，HIV 感染者的 COVID-19 发病率相似或更低。然而，发病率可能会受到弱势群体检测率较低的影响。我们旨在比较在县级医院系统中接受护理的 HIV 感染者和非 HIV 感染者在 3 个月期间 SARS-CoV-2 IgG 血清阳性率、疾病严重程度和感染后中和抗体活性。
在这项匹配病例对照观察性研究中，于 2020 年 8 月 1 日至 10 月 31 日，从所有在市政卫生保健系统（美国加利福尼亚州旧金山总医院）进行常规门诊实验室检测的 HIV 感染者中采集剩余血清样本。HIV 感染者的样本按采集日期（同日）和年龄（±5 岁）与在同一医院接受慢性疾病护理的随机选择的年龄在 18 岁或以上的非 HIV 感染者的样本相匹配。我们通过混合效应逻辑回归模型比较 HIV 感染者和非 HIV 感染者的血清阳性率，考虑到数据的匹配结构（匹配组的随机效应），并调整年龄、性别、种族或民族以及临床因素（即心血管或肺部疾病史和 2 型糖尿病）。通过病历回顾评估有既往 SARS-CoV-2（IgG 或 PCR）感染史的参与者中的严重 COVID-19，并通过多变量混合效应逻辑回归进行比较，调整年龄和性别。对既往 PCR 阳性检测的参与者的 SARS-CoV-2 IgG、中和抗体滴度和抗体亲和力进行了检测，并通过多变量混合效应模型进行了比较，调整了年龄、性别和 PCR 确诊 SARS-CoV-2 感染后的时间。
对 955 名 HIV 感染者的 1138 份样本和 1062 名非 HIV 感染者的 1118 份样本进行了检测。与非 HIV 感染者的 7.4%（5.7%至 9.2%）相比，HIV 感染者的 SARS-CoV-2 IgG 血清阳性率为 3.7%（2.4%至 5.0%）（调整后的优势比 0.50，95%置信区间 0.30 至 0.83）。在 31 名 HIV 感染者和 70 名非 HIV 感染者中有 SARS-CoV-2 既往感染证据的参与者中，HIV 感染者发生严重 COVID-19 的几率是非 HIV 感染者的 5.52 倍（95%置信区间 1.01 至 64.48）。调整 PCR 确诊感染后的时间，与非 HIV 感染者相比，HIV 感染者的 SARS-CoV-2 IgG 浓度降低（百分比变化-53%，95%置信区间-4%至-76%），假病毒中和抗体滴度降低（-67%，-25%至-86%），亲和力相似（7%，-73%至 87%）。
尽管 HIV 感染者的 SARS-CoV-2 IgG 检测中检测到的感染较少，但 HIV 感染者的严重 COVID-19 病例更多。在有既往 SARS-CoV-2 感染的 HIV 感染者中，较低的 IgG 浓度和假病毒中和抗体滴度可能反映了感染后的血清学反应减弱，而相似的亲和力可能是由于感染后时间相似所致。
美国国立过敏和传染病研究所，美国国立卫生研究院。
Zotero 插件
