key: cord-0939257-ec0xpwom
authors: Peluso, Michael J; Bakkour, Sonia; Busch, Michael P; Deeks, Steven G; Henrich, Timothy J
title: A High Percentage of People with HIV on Antiretroviral Therapy Experience Detectable Low-Level Plasma HIV-1 RNA Following COVID-19
date: 2020-11-19
journal: Clin Infect Dis
DOI: 10.1093/cid/ciaa1754
sha: eb247b741a0f35a0a42c79505ca31f95440bd342
doc_id: 939257
cord_uid: ec0xpwom

nan

M a n u s c r i p t 2 Dear Editor, We read with interest the recent article by Geretti et al. (October 2020) in which among adults under the age of 60 with acute SARS-CoV-2 infection, HIV seropostivity was shown to be significantly associated with 28-day mortality, even when adjusted for age and other potentially important factors (1) . As the authors discuss in detail, these data contrast with an earlier study recently published in Clinical Infectious Diseases by Sigel et al. of people with HIV (PWH) who were hospitalized for acute SARS-CoV-2; in this study, there were no differences in adverse outcomes compared to a demographically similar HIV-seronegative group (1) . While a number of case series and retrospective studies have also shown no differences in COVID-19 mortality or severity in PWH (2) (3) (4) (5) (6) (7) , there is emerging evidence for exacerbations of lymphocyte dysfunction and aberrant immune activation in the setting of SARS-CoV-2/HIV coinfection (8) . Furthermore, COVID-19 often leads to increased markers of immune activation, inflammation and immune dysregulation, regardless of concomitant chronic infections (9) . It is therefore plausible that, in addition to HIV modulating SARS-CoV-2 infection, COVID-19 may have a short or longer-term impact on HIV disease following acute SARS-CoV-2 infection in PWH on effective antiretroviral therapy (ART). As a result, we sought to identify if SARS-CoV-2/HIV-1 coinfection may lead to an increase the frequency of detectable, but low-level plasma HIV-1 RNA levels that would not necessarily be detected by clinical viral load assays.

We tested large volumes of plasma for HIV-1 RNA using a highly sensitive single copy assay (SCA) from 12 PWH on ART using a replicate (9x) technology as previously described (10) with PCR-confirmed, convalescent SARS-CoV-2 infection a median of 37 days since onset of COVID-19 symptoms, and from 17 PWH on ART with plasma collection prior to COVID-19 (March 2018 -October 2019). 

MPB reports subsidized funding for HIV VL testing from Hologic, outside the submitted work. SB reports that Hologic, Inc. (San Diego, CA) provided a Panther instrument used to perform the replicate Aptima testing for this study through a grant to VRI. TH reports grants from NIH/NIAID, Bristol Myers Squibb, and Gilead Biosciences, and personal fees from Merck & Co., outside the submitted work.

A c c e p t e d M a n u s c r i p t M a n u s c r i p t 7 

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