Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL.
Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston MA.
J Acquir Immune Defic Syndr. 2022 Aug 1;90(4):377-381. doi: 10.1097/QAI.0000000000003000.
Limited data are available regarding asymptomatic COVID-19 among people with HIV (PWH). Data on a representative subset of PWH enrolled in Randomized Trial to Prevent Vascular Events in HIV, a global clinical trial, are presented here.
Randomized Trial to Prevent Vascular Events in HIV is an atherosclerotic cardiovascular disease prevention trial among 7770 PWH on antiretroviral therapy. Beginning April 2020, targeted data on coronavirus disease 2019 (COVID-19) diagnosis and symptoms were collected during routine trial visits. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was defined as either COVID-19 clinical diagnosis or presence of SARS-CoV-2 Immunoglobulin G (IgG) or Immunoglobulin A (IgA) receptor binding domain protein (antispike) antibodies in the absence of prior COVID-19 vaccine.
The group (N = 2464) had a median age 53 years, 35% female sex, 47% Black or African American race, median CD4 count 649 c/mm 3 , and 97% with HIV VL <400 cp/m. SARS-CoV-2 infection occurred in 318 persons (13%): 58 with clinical diagnosis and 260 with detectable antibodies. Of these PWH, 304 completed symptom questionnaires: 121 (40%) reported symptoms, but 183 (60%) were asymptomatic. PWH with asymptomatic SARS-CoV-2 infection were more likely to be from low-income or middle-income regions, of Black or African American race, older in age, and with higher atherosclerotic cardiovascular disease risk score. Symptomatic COVID was more common with obesity, metabolic syndrome, and low HDL levels. CD4 counts and HIV viral suppression rates were similar among PWH with symptomatic vs. asymptomatic COVID.
Asymptomatic SARS-CoV-2 infection is common among antiretroviral therapy-treated PWH globally. We determined that 60% of infections in PWH were asymptomatic. HIV clinicians must remain vigilant about COVID-19 testing among PWH to identify asymptomatic cases.
目前关于 HIV 感染者（PWH）中无症状 COVID-19 的数据有限。在此呈现了在一项名为预防 HIV 血管事件的随机试验（Randomized Trial to Prevent Vascular Events in HIV）中，对该全球临床试验中纳入的代表性 PWH 亚组人群的数据。
预防 HIV 血管事件的随机试验是一项针对正在接受抗逆转录病毒治疗的 7770 名 PWH 的动脉粥样硬化性心血管疾病预防试验。自 2020 年 4 月开始，在常规试验访视期间，有针对性地收集了关于 2019 年冠状病毒病（COVID-19）诊断和症状的数据。严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染的定义为 COVID-19 临床诊断，或在没有先前 COVID-19 疫苗接种的情况下存在 SARS-CoV-2 免疫球蛋白 G（IgG）或免疫球蛋白 A（IgA）受体结合域蛋白（刺突）抗体。
该组（N=2464）的中位年龄为 53 岁，35%为女性，47%为黑种人或非裔美国人，中位 CD4 计数为 649 c/mm3，97%的 HIV VL <400 cp/m。318 人（13%）发生 SARS-CoV-2 感染：58 人有临床诊断，260 人有可检测到的抗体。在这些 PWH 中，有 304 人完成了症状问卷：121 人（40%）报告有症状，但 183 人（60%）无症状。无症状 SARS-CoV-2 感染的 PWH 更可能来自低收入或中等收入地区，为黑种人或非裔美国人，年龄较大，且动脉粥样硬化性心血管疾病风险评分较高。肥胖、代谢综合征和低 HDL 水平与 COVID 症状更常见相关。有症状与无症状 COVID 的 PWH 的 CD4 计数和 HIV 病毒抑制率相似。
在接受抗逆转录病毒治疗的 PWH 中，无症状 SARS-CoV-2 感染很常见。我们确定，60%的感染是无症状的。HIV 临床医生必须对 PWH 的 COVID-19 检测保持警惕，以识别无症状病例。
