Background Limited data are available regarding asymptomatic COVID-19 among people with HIV (PWH). Data on a representative subset of PWH enrolled in REPRIEVE, a global clinical trial are presented here.
Methods REPRIEVE is an atherosclerotic cardiovascular disease (ASCVD) prevention trial among 7,770 PWH on antiretroviral therapy (ART). Beginning April 2020, targeted data on COVID-19 diagnosis and symptoms were collected during routine trial visits. SARS-CoV-2 infection was defined as either COVID-19 clinical diagnosis or presence of SARS-CoV-2 IgG or IgA RBD protein (anti-spike) antibodies in the absence of prior COVID-19 vaccine.
Results The group (N=2,464) had a median age 53 years, 35% female sex, 47% Black or African American race, median CD4 count 649 c/mm3, 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 or Middle Income Regions, of Black or African American race, older in age, and with higher ASCVD 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.
Conclusions Asymptomatic SARS-CoV-2 infection is common among ART-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.