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COVID-19 epidemiology and performance of the WHO clinical algorithm to diagnose COVID-19 in people with HIV from
Marta Vasylyev1,2, Vira Buhiichyk2, Nadiia Buhiichyck2
1Department of Internal Medicine, Section Infectious Diseases, and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands.
Insights
The WHO case definition showed insufficient accuracy for diagnosing COVID-19 in people with HIV in Ukraine. Despite a significant COVID-19 rate, a lower burden was observed in vulnerable populations, possibly due to shielding.
Area of Science:
- Infectious disease epidemiology
- Clinical virology
- Public health
Background:
- Assessing COVID-19 prevalence and diagnostic test performance in people with HIV is crucial.
- The WHO case definition's utility in this population requires evaluation.
Purpose of the Study:
- To determine the point prevalence of COVID-19 among unvaccinated individuals with HIV in West Ukraine.
- To evaluate the diagnostic accuracy of the World Health Organization (WHO) case definition for clinical COVID-19 in this cohort.
Main Methods:
- A multicenter cross-sectional study was conducted in Lviv, Ukraine, from October 2020 to November 2021.
- Unvaccinated individuals with HIV underwent clinical assessments, quality of life surveys (EQ-5D), and SARS-CoV-2 serology.
- The WHO case definition was used to classify symptoms, and clinical COVID-19 was defined as SARS-CoV-2 seropositivity with at least suspected COVID-19.
Main Results:
- Of 971 participants, SARS-CoV-2 seroprevalence was 40.1%, with 20.5% having clinical COVID-19.
- Clinical COVID-19 was less frequent in those with a history of tuberculosis, injecting drug use, low CD4+ T-cell counts, or unemployment.
- The WHO case definition (probable or confirmed) demonstrated 44.1% sensitivity and 85.2% specificity for diagnosing COVID-19.
Conclusions:
- Individuals with HIV in Ukraine had a substantial COVID-19 infection rate.
- The WHO case definition exhibited inadequate diagnostic accuracy for identifying clinical COVID-19 in this population.
- Unexpectedly lower COVID-19 burden in vulnerable subgroups may suggest a shielding effect.
Background:
The two main objectives were to evaluate the COVID-19 point prevalence and the test performance of the WHO case definition to diagnose COVID-19 clinically in people with HIV in West Ukraine.
Methods:
Multicenter cross-sectional study in Lviv, Ukraine, from October 2020-November 2021. COVID-19 unvaccinated people with HIV were included regardless of COVID-19 symptoms at routine clinical visits and had standardized medical, quality of life (EQ(5D)) and SARS-CoV-2 serology assessments. Reported symptoms indicating potential COVID-19 events at inclusion or between March 2020 and inclusion were classified by the WHO case definition as suspected, probable or confirmed. A clinical COVID-19 case was defined as being SARS-CoV-2 seropositive with at least a suspected COVID-19 according to the WHO case definition. The primary endpoints were the clinical COVID-19 prevalence and the test characteristics of the WHO case definition with SARS-CoV-2 serology as reference. (Clinicaltrials.gov:NCT04711954).
Results:
The 971 included people with HIV were median 40 years, 38.8% women, 44.8% had prior AIDS, and 55.6% had comorbidities. SARS-CoV-2 seroprevalence was 40.1% (95%CI:37.0-43.1) and 20.5% (95%CI:18.0-23.1) had clinical COVID-19 median 4 months (IQR:2-7) before inclusion. Clinical COVID-19 occurred less frequently in people with HIV with tuberculosis history, injecting drug use, CD4+ T-cells <200/mL and unemployment. The quality of life was not impacted after COVID-19. An at least probable COVID-19 classification by the WHO case definition had 44.1% sensitivity (95%CI:38.7-49.7), 85.2% specificity (95%CI:81.5-88.4), 66.6% positive predictive value (95%CI:59.8-73.0) and 69.5% negative predictive value (95%CI:65.5-73.3) to diagnose COVID-19.
Conclusions:
COVID-19 unvaccinated people with HIV from Ukraine had a significant COVID-19 rate and using the WHO case definition had insufficient diagnostic accuracy to diagnose these cases. The lower burden in vulnerable people with HIV was unexpected but might reflect a shielding effect.
