People Living With HIV have a prolonged virus shedding duration even with anti-SARS-CoV-2 treatment：a retrospective cohort study in Wuhan, China

Objective This study aimed to investigate the clearance of SARS-CoV-2 in people living with HIV (PLWH) after receiving anti-SARS-CoV-2 treatment and the relevant factors. Methods A retrospective investigation was conducted based on clinical data of patients with anti-SARS-CoV-2 treatment between December 2022 and June 2023. The patients were categorized into PLWH and HIV-negative groups. Basic information, comorbidity, COVID-19 severity, white blood cell count, lymphocyte count, anti-SARS-CoV-2 medicine, steroid usage, and SARS-CoV-2 virus shedding duration were collected. The Kaplan-Meier curve was employed to compare virus shedding rates, and multivariate logistic regression and Cox regression analyses were utilized to identify factors influencing SARS-CoV-2 virus shedding duration. Results A total of 149 patients with COVID-19 (32 PLWH and 117 HIV-negative individuals) were enrolled in the study. The median estimated virus shedding duration for PLWH group and HIV-negative group are 21 days and 14 days, respectively (P < 0.001). The virus shedding rates at the 5th day were 15.63% and 60.68% (P < 0.001), and at the 28th day were 87.50% and 97.44% (P = 0.019) for PLWH and HIV-negative groups, respectively. Multivariate logistic regression analysis showed that HIV infection (OR = 0.026, 95% CI: 0.004–0.159) and lymphocyte count at admission (OR = 4.341, 95% CI: 1.536–12.265) were independent factors influencing virus shedding at 5th day (P < 0.05). Compared to the mild COVID-19 group, the moderate and severe groups had significant impacts on virus shedding at both the 5th and the 28th day (P < 0.05). Multivariate Cox regression analysis revealed that age (OR = 0.977, 95% CI: 0.963–0.991), HIV infection (OR = 0.351, 95% CI: 0.197–0.626), duration of anti-SARS-CoV-2 therapy initiation (OR = 0.827, 95% CI: 0.786–0.871), and lymphocyte count (OR = 1.999, 95% CI: 1.372–2.914) were independent factors influencing SARS-CoV-2 virus shedding duration at the 28th day (P < 0.05). Compared to the mild COVID-19 group, the moderate, severe, and critically ill groups had statistically significant impacts on nucleic acid conversion (P < 0.001). Conclusion PLWH with COVID-19 had a prolonged virus shedding duration even with anti-SARS-CoV-2 treatment, which could lead to more opportunities to accumulate multiple mutations and induce resistance to anti-SARS-CoV-2 medicines.