Background
Some individuals recovering from COVID-19 experience persistent symptoms after initial infection, a condition known as Long Covid (LC). Persons with vs without HIV (PWH; PWoH) are hypothesized to be at greater risk of LC due to chronic immune dysregulation. However, existing data are sparse and conflicting due to inconsistent definitions of LC. We used the RECOVER Scoring System (RSS) to define and assess the burden and pattern of LC presentation in PWH vs PWoH who had prior COVID-19 in the MACS/WIHS Combined Cohort Study (MWCCS).
Methods
We included MWCCS participants who self-reported a positive COVID-19 test between 04/2020 and 11/2023. Participants who completed the prospectively administered COVID-19 survey including symptom type and duration between 30 and 365 days after COVID-19 infection date were evaluated for LC. LC was defined using the RSS, which weights 12 common LC symptoms according to strongest association with LC in and sums the weights for a total score. Participants with total scores ≥12 met criteria for LC. Among those with LC, we characterized LC symptom type by HIV serostatus, sex, and COVID-19 vaccination status using chi-square tests.
Results
Of 4,970 participants, 1,616 (33%) reported a positive COVID test during the study period, of whom 153 (10%) met RSS criteria for LC. Among PWH who reported having COVID, 97/1010 (9.6%) had LC, compared to 56/606 (9.2%) of PWoH (p=0.89). Among persons with LC, half were female, 63% were PWH (median CD4 758 cells/mm3; 91% had HIV RNA <200 cp/ml), and most (93%) had received 1 dose of COVID vaccine at time of survey. Overall, the most common LC symptoms were chronic cough (94%), post-exertional malaise (93%), and loss of smell/taste (88%), while the least common were brain fog (28%), dizziness (19%), and palpitations (13%). There was no significant difference in LC symptom type by HIV serostatus (Figure). Neither sex nor vaccination status had measurable impact on LC prevalence or symptom type in the study population.
Conclusions
Using the highly specific yet conservative RSS to define LC, PWH and PWoH were similarly likely to develop LC after an acute COVID-19 infection. LC symptoms were similar in both PWH and PWoH. Our study is limited by the relatively small number of individuals with LC. These findings will inform work on assessing the trajectory of LC symptoms over time and by comorbidity status to better understand their progression and implications.