Duration of SARS-CоV-2 virus shedding in COVID-19 patients with HIV infection

The aim: to describe the duration of SARS-CoV-2 virus shedding in patients with HIV infection and to identify factors associated with prolonged viral shedding.

Materials and methods: in a prospective study, the clinical and laboratory characteristics of COVID-19 and HIV infection and the duration of SARS-CoV-2 virus shedding were compared in 170 patients, titers of virus neutralizing antibodies to SARSCoV-2 were identified in 68 patients; pathogen genotyping was performed in 36 patients. Statistical analysis was carried out using the IBM SPSS Statistics package.

Results and discussion: there were no significant differences in the duration of SARS-CoV-2 virus shedding in patients with varying severity grade of COVID-19; a negative relationship between the titer of virus neutralizing antibodies to SARS-CoV-2 and viral shedding duration was revealed. In 35.9% of patients (61 persons), the persistence of the virus lasted for more than 21 days, this group was characterized by an unfavorable course of HIV infection in the absence of ART, significantly lower CD4 cell values and a higher HIV viral load in the blood. Virus shedding was shown to be significantly longer in patients with B.1.1 strain versus other SARS-CoV-2 gene variants. Mutations in the Spike protein gene that increase the infectious ability of the pathogen and reduce its sensitivity to neutralizing antibodies were found in 4 patients.

Conclusion: the severity of COVID-19 did not affect the duration of SARS-CoV-2 virus shedding in patients with HIV infection. Long-term persistence of the virus was discovered in patients with severe immunodeficiency (CD4<200 cl/μl) in the absence of ART. Patients with prolonged viral shedding pose an epidemiological risk in regard to developing new mutational variants of the pathogen.

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