南非免疫功能低下的人类免疫缺陷病毒（HIV）感染者住院患者中高病毒载量下严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）的长时间脱落。
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.
机构信息
Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa.
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
出版信息
Clin Infect Dis. 2022 Aug 24;75(1):e144-e156. doi: 10.1093/cid/ciac077.
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.
背景
我们评估了人类免疫缺陷病毒（HIV，PLHIV）感染者体内严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）RNA 的脱落持续时间和程度。
方法
2020 年 5 月至 12 月，我们在南非的 20 家医院开展了一项前瞻性队列研究。招募因有症状的 2019 年冠状病毒病（COVID-19）住院的成年人，并每 2 天用鼻咽/口咽（NP/OP）拭子进行随访，直到记录到 SARS-CoV-2 脱落停止（连续 2 次 NP/OP 拭子阴性）。对 SARS-CoV-2 进行实时逆转录-聚合酶链反应检测，Ct 值<30 被认为是 SARS-CoV-2 高病毒载量的替代指标。使用加速时间失效 Weibull 回归模型评估与延长脱落相关的因素。
结果
在筛查的 2175 例 COVID-19 患者中，有 300 例被纳入，257 例（155 例未感染 HIV 和 102 例 PLHIV）有>1 次拭子检测（中位数 5 次就诊[范围 2-21]）。停止脱落的中位时间为 13 天（四分位距 [IQR] 6-25），与 HIV 感染无显著差异。在具有初始呼吸道样本 Ct 值<30 的 94 例患者（41 例 PLHIV 和 53 例未感染 HIV）亚组中，高 SARS-CoV-2 病毒载量的脱落中位时间为 8 天（IQR 4-17）。与未感染 HIV 的人相比，CD4 计数<200 个细胞/μL 的 PLHIV 的脱落时间明显更长（中位数 27 天[IQR 8-43] vs 7 天[IQR 4-13]；调整后的危害比[aHR]0.14，95%置信区间[CI]0.07-0.28，P<0.001），未接受抑制 HIV 治疗的 PLHIV 与未感染 HIV 的人相比也是如此。
结论
尽管 HIV 感染对 SARS-CoV-2 的脱落持续时间无显著影响，但在具有高初始 SARS-CoV-2 病毒载量的亚组中，免疫功能低下的 PLHIV 比未感染 HIV 的人具有更高的病毒载量的 SARS-CoV-2 脱落时间更长。更好的 HIV 控制可能会降低 SARS-CoV-2 的传播时间。
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