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Background <p>Persons living with HIV (PLWH) were prioritized for SARS-CoV-2 vaccination in sub-Saharan Africa, however, SARS-CoV-2 infection and COVID-19 symptomatology have not been well characterized among PLWH. We described SARS-CoV-2 infection prevalence and symptomatology, and examined factors associated with nasal swab RT-PCR positivity in Kenya, Uganda, Tanzania, and Nigeria.</p> Methods <p>The ongoing African Cohort Study (AFRICOS) follows PLWH and people living without HIV (PLWoH) in four African countries. All participants undergo clinical assessment and socio-behavioral questionnaire administration at enrollment and each six-monthly visits, with CD4 count and viral load collected for PLWH. Optional nasal swabs were collected for SARS-CoV-2 rapid RT-PCR testing at visits after 19 July 2022. Participants were asked if they had experienced COVID-19 symptoms. We used the Agresti-Coull method to estimate the prevalence of SARS-CoV-2 infection at each participant’s first nasal swab collection. Adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for factors potentially associated with SARS-CoV-2 infection were estimated using multivariable robust Poisson regression.</p> Results <p>Between 19 July 2022 and 1 March 2024, 1,187 participants underwent nasal swab collection with a valid SARS-CoV-2 RT-PCR result; 1,032 (86.9%) were PLWH and 155 (13.1%) were PLWoH. A majority were female (57.2%), and the median age was 44.6 (interquartile range 34.4–52.2) years. Prevalence at first nasal swab of SARS-CoV-2 was 6.8% (95%CI 5.5%-8.4%). Most participants with positive SARS-CoV-2 RT-PCR were asymptomatic (97.5%). SARS-CoV-2 was marginally more common among PLWoH as compared to PLWH (10.3% vs. 6.3%; <i>p</i> = 0.093). In the multivariable model, SARS-CoV-2 was significantly more common among participants who received at least one dose of a COVID-19 vaccine as compared to participants who received no doses (aPR 1.66; 95%CI 1.05–2.62; <i>p</i> = 0.031) and during the omicron wave as compared to non-wave periods (aPR 2.15; 95%CI 1.42–3.25; <i>p</i> &lt; 0.001). Among PLWH, CD4 and viral load were not associated with SARS-CoV-2 prevalence.</p> Conclusion <p>The vast majority of people with positive SARS-CoV-2 RT-PCR were asymptomatic. Universal screening may be needed to fully understand the epidemiology of SARS-CoV-2 and future outbreaks of similar respiratory viruses, capture early infection, and plan for intervention.</p>

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The vast majority of SARS-CoV-2 infections were asymptomatic in a clinic-based cohort of people with and without HIV in four African countries

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  • 发表日期：

    2025年3月12日

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  • Rither Langat,
  • Natalie Burns,
  • Ibrahim Daud,
  • Hannah Kibuuka,
  • John Owuoth,
  • Valentine Sing’oei,
  • Jonah Maswai,
  • Zahra Parker,
  • Abdulwasiu Tiamiyu,
  • Emmanuel Bahemana,
  • Reginald Gervas,
  • Nicole F. Dear,
  • Seth Frndak,
  • Ajay P. Parikh,
  • Emma R. Duff,
  • Michelle Imbach,
  • Badryah Omar,
  • Jaclyn Hern,
  • Neha Shah,
  • Julie A. Ake,
  • Trevor A. Crowell,
  • Matthew L. Romo,
  • Alexus Reynolds,
  • Brennan Cebula,
  • Danielle Bartolanzo,
  • Glenna Schluck,
  • Jacob Patterson,
  • Jillian Chambers,
  • Kara Lombardi,
  • Kimberly Bohince,
  • Leigh Anne Eller,
  • Linsey Scheibler,
  • Mary Schmitz,
  • Patricia Agaba,
  • Sean Cavanaugh,
  • Tsedal Mebrahtu,
  • Agatha Mugagga Mukanza,
  • Alfred Lutaaya,
  • Anne Nakirijja,
  • Benard Okanyakure,
  • Betty Mwesigwa,
  • Cate Kafeero,
  • Christine Nabanoba,
  • Christine Nanteza,
  • Claire Nakazzi Bagenda,
  • Estella Birabwa,
  • Evelyn Najjuma,
  • Ezra Musingye,
  • Fred Magala,
  • Freddie Ssentogo,
  • Godfrey Zziwa,
  • Grace Mirembe,
  • Harriet Nabirye,
  • Hellen Birungi,
  • Hilda Mutebe,
  • Isaac Kato Kenoly,
  • Jacqueline Namugabo,
  • Michael Semwogerere,
  • Michael Waiswa,
  • Paul Wangiri,
  • Phiona Namulondo,
  • Prossy Naluyima,
  • Richard Tumusiime,
  • Ronald Ephraim Wasswa,
  • Sylvia Namanda,
  • Vamsi Vasireddy,
  • Aaron Ngeno,
  • Aggrey Koech,
  • Alice Airo,
  • Bornes Ngtech,
  • Brayan Langat,
  • Christopher Ochieng,
  • Deborah Langat,
  • Edwin Langat,
  • Francis Opiyo,
  • Grace Engoke,
  • Ignatius Kiptoo,
  • Irene Metet,
  • Isaac Tsikhutsu,
  • Janet Ngeno,
  • Japhet Towett,
  • Joan Kapkiai,
  • Joshua Rotich,
  • Josphat Kosgei,
  • Kennedy Labosso,
  • Leonard Cheruiyot,
  • Linner Rotich,
  • Lucy Korir,
  • Mary Leelgo,
  • Mercy Chelimo,
  • Michael Obonyo,
  • Mike Bii,
  • Raphael Langat,
  • Salome Ndungu,
  • Samuel Kiprotich,
  • Susan Ontango,
  • Triza Rono,
  • Wilfred Kirui,
  • Zeddy Bett Kesi,
  • Agnes Atieno,
  • Celine Ogari,
  • Charles Okwaro,
  • Doris Njoroge,
  • Elkanah Modi,
  • George Suja,
  • Iddah Aoko,
  • Janet Oyieko,
  • Joseph Meyo,
  • Kennedy Obambo,
  • Lovet Nyawanda,
  • Lucas Otieno,
  • Michal Ohaga,
  • Oscar Adimo,
  • Paul Omolo,
  • Solomon Otieno,
  • Trizer Achieng,
  • Winnie Rehema,
  • Dorothy Mkondoo,
  • Eliud Myegeta,
  • Faraja Mbwayu,
  • Gloria David,
  • Goodluck Kisonga,
  • Gwamaka Mwaisanga,
  • Happy Laiton,
  • Janeth Likiliwike,
  • Jaquiline Mwamwaja,
  • John Njegite,
  • Johnisius Msigwa,
  • Laban Mwandumbya,
  • Lucas Maganga,
  • Mtasi Mwaipopo,
  • Naima Mkingule,
  • Paschal Kiliba,
  • Peter Edwin,
  • Raphael Mkinga,
  • Restituta Minde,
  • Rose Bruno,
  • Vumilia Kaduma,
  • Willyhelmina Olomi,
  • Aminu Suleiman,
  • Blessing Edet Okon,
  • Chisara Okolo,
  • Felicia Anayochukwu Odo,
  • Feyisayo Jegede,
  • Helen Nwandu,
  • Ifeanyi Okoye,
  • Ijeoma Chigbu-Ukaegbu,
  • Lawrence Umeji,
  • Mfreke Asuquo,
  • Ndubuisi Okeke,
  • Onyinye Eze,
  • Rosemary Akiga,
  • Samirah Mohammed,
  • Sunday Odeyemi,
  • Abdulkadir Ramatu,
  • Adewale Adelakun,
  • Aire Commodore Edward Akinwale,
  • Blessing Irekpitan Wilson,
  • Chiamaka Modesta Ibeanu,
  • Concilia Uzoamaka Agbaim,
  • Elekwa Chinenye Elizabeth,
  • Igiri Faith,
  • Jacinta Elemere,
  • Jumoke Titilayo Nwalozie,
  • Sulaimon Awesu,
  • Maj Christian Etim Efut,
  • Ndubuisi Rosemary Obiageli,
  • Nkechinyere Harrison,
  • Nnadi Theodora Nkiru,
  • Obende Theresa Owanza,
  • Obilor Ifeoma Lauretta,
  • Olutunde Ademola Adegbite,
  • Rachael Eluwa,
  • Uzoegwu Amaka Natalie,
  • Victoria Idi,
  • Yakubu Adamu

摘要

Background

Persons living with HIV (PLWH) were prioritized for SARS-CoV-2 vaccination in sub-Saharan Africa, however, SARS-CoV-2 infection and COVID-19 symptomatology have not been well characterized among PLWH. We described SARS-CoV-2 infection prevalence and symptomatology, and examined factors associated with nasal swab RT-PCR positivity in Kenya, Uganda, Tanzania, and Nigeria.

Methods

The ongoing African Cohort Study (AFRICOS) follows PLWH and people living without HIV (PLWoH) in four African countries. All participants undergo clinical assessment and socio-behavioral questionnaire administration at enrollment and each six-monthly visits, with CD4 count and viral load collected for PLWH. Optional nasal swabs were collected for SARS-CoV-2 rapid RT-PCR testing at visits after 19 July 2022. Participants were asked if they had experienced COVID-19 symptoms. We used the Agresti-Coull method to estimate the prevalence of SARS-CoV-2 infection at each participant’s first nasal swab collection. Adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for factors potentially associated with SARS-CoV-2 infection were estimated using multivariable robust Poisson regression.

Results

Between 19 July 2022 and 1 March 2024, 1,187 participants underwent nasal swab collection with a valid SARS-CoV-2 RT-PCR result; 1,032 (86.9%) were PLWH and 155 (13.1%) were PLWoH. A majority were female (57.2%), and the median age was 44.6 (interquartile range 34.4–52.2) years. Prevalence at first nasal swab of SARS-CoV-2 was 6.8% (95%CI 5.5%-8.4%). Most participants with positive SARS-CoV-2 RT-PCR were asymptomatic (97.5%). SARS-CoV-2 was marginally more common among PLWoH as compared to PLWH (10.3% vs. 6.3%; p = 0.093). In the multivariable model, SARS-CoV-2 was significantly more common among participants who received at least one dose of a COVID-19 vaccine as compared to participants who received no doses (aPR 1.66; 95%CI 1.05–2.62; p = 0.031) and during the omicron wave as compared to non-wave periods (aPR 2.15; 95%CI 1.42–3.25; p < 0.001). Among PLWH, CD4 and viral load were not associated with SARS-CoV-2 prevalence.

Conclusion

The vast majority of people with positive SARS-CoV-2 RT-PCR were asymptomatic. Universal screening may be needed to fully understand the epidemiology of SARS-CoV-2 and future outbreaks of similar respiratory viruses, capture early infection, and plan for intervention.