Background:
People with HIV (PWH) may be at elevated risk of post-acute sequelae of COVID-19 (PASC), but PASC frequency and risk factors in PWH who initiated antiretroviral therapy (ART) during acute HIV (AHI) is unknown. We assessed pre-COVID-19 characteristics and compared immunologic and neuropsychiatric outcomes of participants with and without PASC in the RV254 AHI study in Thailand.
Methods:
Participants enrolled and initiated ART during AHI, with standardized longitudinal assessment of blood T cell counts and viral load (VL), cognition (Color Trails 1 & 2, Grooved Pegboard, Trail Making A), and mood (Hospital Anxiety & Depression Scale, Patient Health Questionnaire-9). By 7/2023, those ≥1 year after confirmed COVID were stratified as no PASC or PASC by persistence or occurrence of >1 PASC symptom (on a PASC symptom questionnaire) ≥3 months after acute COVID, lasting for >2 months. Demographic characteristics, COVID-19 course (time period/variant, number of infections, and hospitalization), and immunologic, cognitive, and mood parameters pre- and post-COVID-19 were compared in PASC vs no PASC using nonparametric methods.
Results:
216 RV254 participants were assessed a median 15[IQR 13-17] months after acute COVID; 55(25%) had experienced PASC and 15(7%) had ongoing symptoms. Common symptoms were fatigue (55%), exercise intolerance (25%), sleep disturbance (15%), cough (13%), and memory impairment (13%). PASC vs no PASC had similar pre-COVID parameters including median age 30 vs 31 years; 95% vs 98% male; CD4+ count 706 vs 701 cells/ul; pre-COVID VL >50 cps/ml 0% vs 1%; duration from AHI to acute COVID 6.0 vs 5.4 years (all p>.05). Those with PASC had a higher pre-COVID frequency of moderate-to-severe anxiety (HADS-A>11), fewer COVID vaccinations, and higher hospitalization rates with longer median hospital stay (Table 1). No differences were detected in variant type, number of infections, or immunologic and neuropsychiatric measures pre- to post-COVID between PASC and no PASC participants.
Conclusions:
In this cohort of young mostly male PWH on suppressive ART initiated during AHI, 25% experienced PASC and 7% had ongoing symptoms >1year after documented COVID-19. Immunologic and neuropsychiatric changes pre- and post-COVID did not differ in participants with and without PASC. Higher pre-COVID anxiety severity, frequency of COVID hospitalization, and fewer COVID vaccinations associated with PASC, suggesting opportunities to prevent PASC in PWH including mental health interventions and vaccination
