Seroprevalence, Neutralizing Antibody Titers Following Infection, and COVID-19 Disease Severity Differ Among People With and Without HIV

Background: Most cohorts show similar or lower COVID-19 incidence among people living with HIV (PLWH) compared to the general population. However, incidence may be impacted by lower testing rates among vulnerable populations. We compared SARS-CoV-2 IgG seroprevalence, disease severity, and neutralizing antibody activity after infection among people with and without HIV receiving care within a county hospital system over a three-month period. Methods: From August through October 2020, remnant serum samples were collected from all PLWH who underwent routine outpatient laboratory testing in a municipal healthcare system which houses a large HIV clinic. Patients with HIV were date-of-collection and age-matched (same day, +/- 5 years respectively) to adults without HIV. SARS-CoV-2 IgG and neutralizing antibody titers were measured in serum. Severe disease was assessed by chart review. Findings: Overall, 2,256 samples from 955 PLWH and 1062 people without HIV were tested. Among PLWH, the seroprevalence was 3.7% as compared to 7.4% among people without HIV (adjusted odds ratio (AOR) 0·48; 95% Confidence Interval (CI): 0·34; 0·71). Among those with evidence of prior infection (IgG or PCR), the odds of severe disease were more than 5-fold higher among PLWH (OR 5·13 95% CI: 1·05; 38·9). Among those with past infection, SARS-CoV-2 IgG levels were 45% lower among PLWH vs. those without HIV (95% CI: 22%; 61%); neutralizing antibody titers were 63% lower among PLWH (2%-78%). Interpretation: Among PLWH, there were approximately 50% lower odds of past SARS-CoV-2 infection, possibly due to greater non-pharmaceutical intervention adherence among a population with experience of the HIV epidemic. However, in spite of fewer infections, PLWH experienced more cases of severe disease. Among PLWH with past SARS-CoV-2 infection, lower neutralizing antibody titers were observed and may lead to increased risk of severe COVID-19 disease or reinfection. PLWH should be followed after vaccination to ensure they mount and maintain sufficient responses. Funding Statement: This work was funded by NIH/NIAID R01AI158013. Declaration of Interests: MAS, DVG, TJH, MG, and LBB report funding from the NIH during conduct of the study. DVG reports personal fees from Gilead Sciences outside the submitted work. All other authors have nothing to declare. Ethics Approval Statement: As only remnant samples were used, the University of California, San Francisco IRB did not require informed consent for study participation.The UCSF IRB # is 20-30387.