SARS-CoV-2 cross-sectional serosurvey across three HIV-1 therapeutic clinical trials in Africa
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Updated: May 5, 2026
Comprehensive & Cost Effective Laboratory Monitoring of HIV/AIDS: an African Role Model
Published on: October 31, 2010
Emmanuelle Papot1, Tamara Tovar-Sanchez2, Joana Woods3
1Therapeutic and Vaccine Research Program, The Kirby Institute, University of New South Wales Sydney, NSW, Australia.
Insights
This study found a high prevalence of SARS-CoV-2 infection among people with HIV (PWH) in Africa, significantly higher than reported COVID-19 cases. This highlights the need for better diagnostics and management in these populations.
Area of Science:
- Infectious Diseases
- Public Health
- Virology
Background:
- Limited data exist on coronavirus disease 2019 (COVID-19) impact in people with HIV (PWH) within resource-constrained settings.
- Antiretroviral therapies (ART) are crucial for managing HIV-1 infection.
Purpose of the Study:
- To assess severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence in PWH in Africa.
- To characterize features of PWH with and without SARS-CoV-2 infection.
Main Methods:
- A cross-sectional serosurvey was conducted between January and March 2021.
- Serum samples from 549 PWH across 9 African sites were analyzed for SARS-CoV-2 immunoglobulin G antibodies.
- Demographic and medical history data were collected.
Main Results:
- The overall SARS-CoV-2 seroprevalence was 36.2%.
- Participants with a body mass index (BMI) ≥30 kg/m² were more likely to have positive serology (aOR = 2.39).
- Seroprevalence was lower in PWH residing in Cameroon.
Conclusions:
- A substantial level of SARS-CoV-2 seroprevalence was observed in PWH in early 2021.
- The seroprevalence significantly exceeded the number of positive COVID-19 PCR tests reported.
- Findings underscore the importance of serological surveys for understanding disease burden in PWH.
Objective:
Data on the impact of coronavirus disease 2019 (COVID-19) in people with HIV (PWH) are lacking in resource-constrained settings. We utilized existing randomized clinical trials (RCTs) on antiretroviral therapies (ART) in HIV-1 infection to conduct a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serosurvey, between January and March 2021, while characterizing participants' features.
Design:
Cross-sectional serosurvey.
Methods:
Demographic characteristics, medical history and a serum sample were collected from consenting PWH. Samples were analyzed centrally for immunoglobulin G antibodies to recombinant nucleocapsid and spike proteins derived from SARS-CoV-2 using a Luminex based assay.
Results:
The 549 participants recruited in 9 sites across Africa had a median age of 40 years (interquartile range, IQR [34-45]); 63.0% (346) were female. All were on ART; 81.8% (449) had an HIV-1 viral load <50 copies/ml, with CD4 + cell count median at 478/mm 3 (IQR [320-677]). None had received vaccination against SARS-CoV-2. Forty participants (7.3%) had a prior SARS-CoV-2 PCR testing, of whom 10 were positive (1.8%). Crude SARS-CoV-2 seroprevalence was 36.2% (95% confidence interval (CI) [32.2-40.4]). In the explorative multivariable analysis, comparison of the characteristics of PWH with a positive SARS-CoV-2 serology with those with a negative or indeterminate serology: PWH with a body mass index (BMI) ≥30 kg/m 2 were more likely to have a positive serology than those with a BMI <25 (adjusted odds ratio (aOR) = 2.39 [1.48-3.86], P < 0.001); and PWH living in Cameroon were less likely to have a positive serology.
Conclusion:
This study demonstrates a substantial seroprevalence level of SARS-CoV-2 in PWH in the first quarter of 2021, with a marked disparity with the number of COVID-19 PCR tests reported positive.
