Low SARS-CoV-2 Positivity in a Large, Diverse US-Based Study of Persons Affected by HIV

There are limited data on SARS-CoV-2 testing practices and positivity among children and adults affected by HIV. The Pediatric HIV/AIDS Cohort Study enrolls children, youth, and adults with perinatally-acquired HIV (PHIV), non-perinatally-acquired HIV (NPHIV), perinatal HIV exposure but uninfected (PHEU), and infants/children with PHEU across the United States and Puerto Rico. A Health Status Survey was developed and administered from April 2020 to November 2021 to assess cumulative incidence (%) of self-reported (1) SARS-CoV-2 testing uptake and results by HIV status, age, and pandemic period; (2) moderate and severe respiratory illness; and (3) hospitalization. At least one survey was completed for 2,289 participants (PHIV = 444, NPHIV = 644, PHEU = 1201) through November 2021; 62% identified as Black and 33% as Hispanic. Participants' ages (years) ranged from 18-42 in PHIV, 19-57 in NPHIV, and < 1-28 in PHEU. Among PHIV, NPHIV, and PHEU, respectively, 43%, 35%, and 16% reported SARS-CoV-2 testing; of these, 18%, 16%, and 11% testing positive. The proportion tested was similar by race, Hispanic ethnicity, education, and income. Overall, 4% (87/2289) were hospitalized for any illness. 8% (174/2289) reported a respiratory illness "worse than the common cold," of whom 44% (76/174) reported SARS-CoV-2 testing, 49% (37/76) testing positive, and 13% (23/174) were hospitalized. The cumulative incidence of both SARS-CoV-2 positivity and severe COVID-19 disease as of November 2021 was lower than expected among persons affected by HIV. Testing access, uptake, and mitigation strategies in this population may explain these findings and inform strategies to prevent acquisition of respiratory viruses.Trial Registration Not applicable; this is not a clinical trial.