Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus-2 Antibodies among People Living with HIV: A Cross-sectional Study from Tripoli University Hospital

Nader S Shalaka

doi:10.4103/ljms.ljms_1_22

SHORT COMMUNICATION

Year : 2021 | Volume : 5 | Issue : 4 | Page : 162-164

Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus-2 Antibodies among People Living with HIV: A Cross-sectional Study from Tripoli University Hospital

Nader S Shalaka
Department of Infectious Diseases, Tripoli University Hospital; Department of Medicine, The University of Tripoli, Tripoli, Libya

Date of Submission	25-Dec-2021
Date of Acceptance	28-Dec-2021
Date of Web Publication	28-Feb-2022

Correspondence Address:
Dr. Nader S Shalaka
Department of Infectious Diseases, Building 3, Ground Floor, Room 140, Tripoli University Hospital, AinZara, Tripoli
Libya

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ljms.ljms_1_22

Abstract

Background/Aims: Patients with preexisting morbidities (e.g., malignancy, posttransplant, and heart failure) are recognized to be at increased risk of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, as well as increased risk of mortality after infection. However, there are conflicting data on the susceptibility and prevalence of infection among people living with HIV (PLWH), with higher, lower, and equal prevalence to the general population were reported. The aim of this study was to assess the prevalence of SARS-CoV-2 antibodies among PLWH who are attending clinical care at the Department of Infectious Diseases of Tripoli University Hospital. Materials and Methods: A cross-sectional study conducted during the period from October 01, 2021 to December 01, 2021 at the (Department of Infectious Diseases) outpatient clinic of Tripoli University Hospital. The OnSite Coronavirus Disease 2019 IgG/IgM Rapid Test (CTK Biotech, San Diego County, California, USA) was used to determine the presence of antibodies against the spike protein of SARS-CoV-2 in the collected serum samples. The test results were reported as “Negative” or “Positive” as per the manufacturer's instructions. Results: A total of 108 PLWH were included in the study. Sixty-nine (64%) were male, and the mean age for participants was 44 years. Specific IgG/IgM antibodies for SARS-CoV-2 were detected in 31 individuals, representing a seroprevalence of 28.7%. Conclusions: High seroprevalence of SARS-CoV-2 antibodies among nonvaccinated PLWH attending clinical care at Tripoli University Hospital. They require pritorization on vaccination and boosting.

Keywords: HIV, Libya, prevalence, Severe acute respiratory syndrome coronavirus-2

How to cite this article:
Shalaka NS. Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus-2 Antibodies among People Living with HIV: A Cross-sectional Study from Tripoli University Hospital. Libyan J Med Sci 2021;5:162-4

How to cite this URL:
Shalaka NS. Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus-2 Antibodies among People Living with HIV: A Cross-sectional Study from Tripoli University Hospital. Libyan J Med Sci [serial online] 2021 [cited 2023 Mar 27];5:162-4. Available from: https://www.ljmsonline.com/text.asp?2021/5/4/162/338627

Introduction

By the end of December 2021, more than 280 million cases of coronavirus disease 2019 (COVID-19) have been reported globally, with almost 5.5 million deaths since the start of the epidemic.^[1] In Libya, 388,000 cases were reported as of December 30, 2021; all of whom had at least one positive polymerase chain reaction (PCR) test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.^[2]

Patients with preexisting morbidities (e.g., malignancy, posttransplant, and heart failure) are recognized to be at increased risk of SARS-CoV-2 infection, as well as increased risk of mortality after infection.^[3],[4],[5] However, there are conflicting data on susceptibility and prevalence of infection among people living with HIV (PLWH), with higher,^[6],[7] lower,^[8],[9] and equal prevalence^[10],[11] to the general population were reported.

The diagnosis of SARS-CoV-2 infection using the PCR-based tests may underestimate the incidence and prevalence of cases as asymptomatic people are generally not studied. In addition, testing rates might be low in the vulnerable populations such as PLWH.

Seroprevalence studies could accurately determine the recent and previous infections in the general population as well as in a prespecified population of interest. They provide better insight of infection dynamics and proportion of subclinical cases.

In this study, we aimed to assess the prevalence of SARS-CoV-2 antibodies among PLWH who are attending clinical care at the Department of Infectious Diseases of Tripoli University Hospital (TUH), a tertiary referral center.

Subjects and Methods

Ethical Consideration

This study was conducted in accordance with the Declaration of Helsinki on ethical principles for the medical research. The study was submitted to and approved by the local ethics review board of TUH (reference: IDD-2020-011). Written informed consent was waived by the review board as the study had no direct harm to participants, and individually identifiable data would not be made publicly available.

Study Design

This was a cross-sectional study conducted during the period from October 01, 2021 to December 01, 2021 at the Department of Infectious Diseases outpatient clinic of TUH. The test for SARS-CoV-2 IgG/IgM was included in routine follow-up investigations and offered to PLWH who attended their regular follow-up visits during the study period. The test was offered irrespective of known previous COVID-19 infection. PLWH with a previous history of COVID-19 vaccination was excluded from this study.

Materials

A 5 ml of peripheral blood was extracted, centrifuged, and serum was separated. The OnSite COVID-19 IgG/IgM Rapid Test (CTK Biotech, San Diego County, California, USA), a rapid lateral flow immunoassay test with good sensitivity and specificity,^[12],[13] was used to determine the presence of antibodies against the spike protein of SARS-CoV-2 in the collected serum samples. The test results were reported as “Negative” or “Positive” as per the manufacturer's instructions.

Statistical Analysis

Statistical analysis was performed using R: a Language and Environment for Statistical Computing (R Foundation for Statistical Computing; version 4.0.2). Ungrouped quantitative variables were summarized using mean and standard deviation, and bivariate analysis was performed using the t-test. The categorical variables were summarized using the frequency tables and proportions/percentages of total and bivariate analysis was performed using the Chi-squared test. All analyses were two-sided, and P < 0.05 was considered statistically significant.

Results

A total of 108 PLWH were included in the study. Sixty-nine (64%) were male, and the mean age for participants was 44 years. All participants were on HAART, but data on CD4 count and HIV viral load were not available.

Specific IgG/IgM antibodies for SARS-CoV-2 were detected in 31 individuals, representing a seroprevalence of 28.7%. Cases who tested positive were older than their negative counterparts (42 vs. 47; P = 0.0027); however, there was neither gender (P = 0.56) nor HAART (P = 0.58) statistically significant differences between the positive and negative cases.

Discussion

In this study, with serum samples from PLWH on regular follow-up, the prevalence of SARS-CoV-2 antibodies was 28.7%. Such a prevalence is considered high when compared to previously published reports on PLWH from Germany (1.85%),^[10] Italy (0.72%),^[8] the United states (3.5%),^[7] and Spain (8.5%)^[14] but comparable to data from Argentine (33%)^[15] and lower than reports from South Africa (50%).^[16]

Regional variations in SARS-CoV-2 seroprevalence among PLWH might be a reflection to the overall prevalence in the general population. It might also be due to variation in infection awareness and care, social vulnerability, and vaccination coverage.^[17],[18]

The high prevalence among PLWH might be due to increased susceptibility to infection, either due to the altered immune function caused by HIV^[19] or because of the increased prevalence of comorbidities among PLWH.^[20] However, this might also be explained by an underestimation of SARS-CoV-2 seroprevalence in the general population.

Although previous studies suggested a potential protective role for HAART against SARS-CoV-2 infection,^[21] this study did not document such a benefit as all study participants were on HAART.

Our study has limitations that should be acknowledged. First, we were only able to provide information about previous exposure, and it is not clear whether IgG levels detected in PLWH in our study are protective and how long such protection may last. Second, lack of recent patient data on CD4 count and HIV viral load hindered further assessment of their contribution to infection susceptibility. Third, because of the weekly evolving dynamic of SARS-CoV-2 infections in Libya, our study may only represent a snapshot in time and reflects the circumstances of the period in which the study was performed.

Despite limitations, this study is the first to provide an approximation to the seroprevalence of SARS-CoV-2 in PLWH in Libya. It indicated a relatively high prevalence of the infection among PLWH that might warrant prioritization on SARS-CoV-2 vaccination and boosting.

Conclusions

We documented a high seroprevalence of SARS-CoV-2 antibodies among nonvaccinated PLWH attending clinical care at TUH. Further research into the response of PLWH to various approved vaccines is necessary to better understand HIV-SARS-CoV-2 immune interaction and to investigate how that might assist in reducing the magnitude and adverse outcome of infection among PLWH.

Acknowledgment

The authors would like to give special thanks to the participants who agreed to participate in this study. Extended thanks to our phlebotomy nurses who assisted in the sample collection.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	World Health Organization. WHO Coronavirus (COVID-19) Dashboard \| WHO Coronavirus (COVID-19) Dashboard with Vaccination Data; 2022. Available from: https://covid19.who.int/. [Last accessed on 2022 Jan 01].
2.	Control National Centre for Disease. COVID-19 Dashboard; 2022. Available from: p https://ncdc.org.ly/Ar/. [Last accessed on 2022 Jan 02].
3.	Roel E, Pistillo A, Recalde M, Fernández-Bertolín S, Aragón M, Soerjomataram I, et al. Cancer and the risk of coronavirus disease 2019 diagnosis, hospitalisation and death: A population-based multistate cohort study including 4618377 adults in Catalonia, Spain. Int J Cancer 2022;150:782-94.
4.	Harrison SL, Fazio-Eynullayeva E, Lane DA, Underhill P, Lip GY. Comorbidities associated with mortality in 31,461 adults with COVID-19 in the United States: A federated electronic medical record analysis. PLoS Med 2020;17:e1003321.
5.	Ssentongo P, Ssentongo AE, Heilbrunn ES, Ba DM, Chinchilli VM. Association of cardiovascular disease and 10 other pre-existing comorbidities with COVID-19 mortality: A systematic review and meta-analysis. PLoS One 2020;15:e0238215.
6.	Sachdev D, Mara E, Hsu L, Scheer S, Rutherford G, Enanoria W, et al. COVID-19 susceptibility and outcomes among people living with HIV in San Francisco. J Acquir Immune Defic Syndr 2021;86:19-21.
7.	Gudipati S, Lee M, Scott M, Yaphe S, Yared N, Brar I, et al. Seroprevalence of antibodies against SARS-CoV-2 among people living with HIV (PLWH). Top Antivir Med 2021;29:243.
8.	Lombardi F, Ricci R, Belmonti S, Fabbiani M, Borghetti A, Baldin G, et al. Seroprevalence of SARS-CoV-2 antibodies in HIV-infected patients in Rome, Italy during the COVID-19 outbreak. Diagnostics (Basel) 2021;11:1154.
9.	Spinelli MA, Lynch KL, Yun C, Glidden DV, Peluso MJ, Henrich TJ, et al. SARS-CoV-2 seroprevalence, and IgG concentration and pseudovirus neutralising antibody titres after infection, compared by HIV status: A matched case-control observational study. Lancet HIV 2021;8:e334-41.
10.	Kaddu-Mulindwa D, Keuser L, Lesan V, Rissland J, Smola S, Werdecker V, et al. IgG seroprevalence of COVID- 19 among people living with HIV or at high risk of HIV in south- west Germany: A seroprevalence study. HIV Med. 2021:1-6.
11.	Noe S, Schabaz F, Heldwein S, Mayer W, Ruecker K, Tiller FW, et al. HIV and SARS-CoV-2 co-infection: Cross-sectional findings from a German 'hotspot'. Infection 2021;49:313-20.
12.	Pallett SJ, Rayment M, Patel A, Fitzgerald-Smith SA, Denny SJ, Charani E, et al. Point-of-care serological assays for delayed SARS-CoV-2 case identification among health-care workers in the UK: A prospective multicentre cohort study. Lancet Respir Med 2020;8:885-94.
13.	Lagerqvist N, Maleki KT, Verner-Carlsson J, Olausson M, Dillner J, Wigren Byström J, et al. Evaluation of 11 SARS-CoV-2 antibody tests by using samples from patients with defined IgG antibody titers. Sci Rep 2021;11:7614.
14.	Berenguer J, Díez C, Martín-Vicente M, Micán R, Pérez-Elías MJ, García-Fraile LJ, et al. Prevalence and factors associated with SARS-CoV-2 seropositivity in the Spanish HIV research network cohort. Clin Microbiol Infect 2021;27:1678-84.
15.	Longueira Y, de la Fuente F, Montesano F, Salomon H, Turk G, Quiroga MF, et al. Seroprevalence of COVID19 in people living with HIV in the Metropolitan Area of Buenos Aires [Article in Spanish]. Actual SIDA Infectol 2021;29:144-9.
16.	Kleynhans J, Tempia S, Wolter N, von Gottberg A, Bhiman JN, Buys A, et al. SARS-CoV-2 seroprevalence in a rural and urban household cohort during first and second waves of infections, South Africa, July 2020-March 2021. Emerg Infect Dis 2021;27:3020-9.
17.	Barry V, Dasgupta S, Weller DL, Kriss JL, Cadwell BL, Rose C, et al. Patterns in COVID-19 vaccination coverage, by social vulnerability and urbanicity – United States, December 14, 2020-May 1, 2021. MMWR Morb Mortal Wkly Rep 2021;70:818-24.
18.	Ritchie H, Mathieu E, Cameron LR, Giattino AC, Ortiz-Ospina E, Bobbie JH, et al. Coronavirus Pandemic (COVID-19). Our World Data; 2021. Available from: https://ourworldindata.org/covid-vaccinations. [Last accessed on 2022 Jan 01].
19.	Ssentongo P, Heilbrunn ES, Ssentongo AE, Advani S, Chinchilli VM, Nunez JJ, et al. Epidemiology and outcomes of COVID-19 in HIV-infected individuals: A systematic review and meta-analysis. Sci Rep 2021;11:6283.
20.	Marcus JL, Leyden WA, Alexeeff SE, Anderson AN, Hechter RC, Hu H, et al. Comparison of overall and comorbidity-free life expectancy between insured adults with and without HIV infection, 2000-2016. JAMA Netw Open 2020;3:e207954.
21.	Del Amo J, Polo R, Moreno S, Díaz A, Martínez E, Arribas JR, et al. Incidence and severity of COVID-19 in HIV-positive persons receiving antiretroviral therapy: A cohort study. Ann Intern Med 2020;173:536-41.