COVID-19 epidemiology and performance of the WHO clinical algorithm to diagnose COVID-19 in people with HIV from...

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.