Chiara Papalini1, Francesco Paciosi1, Elisabetta Schiaroli1, Sara Pierucci1, Chiara Busti1, Silvia Bozza2, Antonella Mencacci2 and Daniela Francisci1.
1 Infectious Diseases Clinic, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
2 Microbiology Department, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
Correspondence to: Chiara Papalini MD. Infectious Diseases Clinic,
Santa Maria della Misericordia Hospital, Sant'Andrea delle Fratte,
06129 Perugia, Italy. Tel.:+390755784375, Fax: +390755784346. E-mail:
kiakka@hotmail.it
Published: November 1, 2020
Received: October 6, 2020
Accepted: October 17, 2020
Mediterr J Hematol Infect Dis 2020, 12(1): e2020080 DOI
10.4084/MJHID.2020.080
This is an Open Access article distributed
under the terms of the Creative Commons Attribution License
(https://creativecommons.org/licenses/by-nc/4.0),
which permits unrestricted use, distribution, and reproduction in any
medium, provided the original work is properly cited.
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To the editor,
Since
the COVID-19 pandemic spread worldwide, great interest has been focused
on persons living with HIV (PLWH). The possibility that these two
infections act synergically[1] and the opinion that antiretroviral treatment could be a protective factor against new coronavirus[2]
animated scientific debate in the last months. Nevertheless, there is
still a paucity of literature about COVID-19 among PLWH. Our study
represents a small contribution to fill the gap. However, it is limited
because Umbria is a 900000-inhabitants Italian region with a low
SARS-CoV2 endemicity.[3]
On May 4, the Italian
government put an end to the lockdown period and started a serological
campaign to detect antibodies against SARS-CoV2 for epidemiological
scope. Taking a cue from that initiative, we tried to estimate the
seroprevalence of anti-SARS-CoV2 antibodies among PLWH visited in the
Infectious Diseases Clinic of Perugia teaching hospital where the
majority of Umbrian PLWH is in charge. For this purpose, we considered
the period from 4th to May 31 because it was the time-lapse immediately after pandemic acme.
The
serological assays' appeal is because their use could have a dual
purpose: to confirm an RT-PCR negative suspected case or surveillance
and epidemiological aim. To make it possible are necessary high
sensitivity and specificity. The best test with these characteristics
is still to clarify, hence our decision to use two different
serological assays. According to what was available in our hospital, we
proposed SCREEN® test COVID-19 (Screen Italia, Torgiano, Perugia,
Italy) as a rapid preliminary test. It is a lateral flow
chromatographic immunoassay for the qualitative detection of IgM/IgG
against SARS-CoV2 and needs a fingerstick whole blood specimen.
Manufacturers reported an accuracy of 98.6% for IgG antibodies
(sensitivity 95% CI: 86-100%; specificity 95% CI: 89.4-99.9%) and 92.9%
for IgM ones (sensitivity 95% CI: 62.1-96.8%; specificity 95% CI:
86.3-99.5%). Each patient positive underwent both nasopharyngeal swab
sampling (Xpert® Xpress SARS-CoV2, Cepheid, Sunnyvale, USA) and further
serological test (ARCHITECT SARS-CoV-2 IgG®, Abbott, USA). The former
is a real-time RT-PCR test for the qualitative detection of SARS-CoV2
RNA, while the latter is a chemiluminescent microparticle immunoassay
for the qualitative detection of IgG antibodies in human serum. For
this kind of serological test, some authors reported sensitivity and
specificity of 92.9% and 99.6 % (95% CI 97.6-100%), respectively, and
higher accuracy than lateral flow tests.[4,5]
We
screened 270 PLWH, all asymptomatic persons, who gave their consent:
mostly males (203/270, 75.2%), native of Italy (204/270 75.5%), and
over 50 years old (158/270, 58.5%). Median age was 52 years (10-83), in
particular 158 (58.5%) over 50 (elderly PLWH) and 10 (3.7%) over 75
years old (geriatric PLWH). Concerning risk factors for the acquisition
of HIV, 79 (29.3%) were homosexual cisgender persons, 136 (50.4%)
heterosexual cisgender, 5 (1.8%) transgender women, 43 (15.9%)
intravenous drug users, 7 (2.6%) had other transmission ways. Smokers
were 110 (40.7%), and 160 (5.2%) had at least one co-morbidity. Quite
all (266/270, 98.5%) were on antiretroviral treatment (ART): NRTIs 216
(81.2%), NNRTIs 75 (28.2%), PIs 44 (16.5%), INIs 206 (77.4%). Despite
146/270 (54%) had nadir CD4 cell below 200/µl, at the last visit, just
14 (5.2%) individuals had CD4 cells count under 200/µl and 153 (56.7%).
At the last visit, the Median CD4 cell number was 649/µl, and 248
(91.8%) patients were virally suppressed. A preliminary serological
test resulted positive for IgM in 2 persons and IgG in 10; they had
both a molecular test and a second serological assay, which turned out
to be negative.
Taken from a total amount of 2907
HIV-seronegative individuals tested in the mentioned period, we
considered, as a control group, 2843 persons within the same range of
age as PLWH and 153/2843 (5.4%) resulted in IgG positive to SCREEN®
test. Among them, 111 (72.5%) had an RT-PCR negative nasopharyngeal
swab, 4 an indeterminate one, 31 were positive, or had the evidence of
a positive result in the past weeks while for 7 no RT-PCR test was
available. For 50 sera, it has been possible to test also ARCHITECT
SARS-CoV-2 IgG®: 41 (82%) was confirmed positive.
Translating
these results on the global number of persons tested, we may estimate
that about 4% of Umbrian inhabitants tested had IgG antibodies against
SARS-CoV2 during the 4th-31st May period.
On
the other hand, nobody of the 270 PLWH analyzed had a serologically
confirmed infection by SARS-CoV2, independently from their risk factors
such as male sex, older age, smoking habit, co-morbidities.[6,7] This result was in agreement with similar Thai findings.[2]
However, in contrast with our Thai colleagues and supported by Italian
data about co-infected patients, either antibody positive either slab
RT-PCR test positive,[8] we do not believe that ART,
and in particular, PIs, had a protective role. In light of our results,
just a minority of patients assumed that kind of drug. Furthermore, the
efficacy of PIs administration against SARS-CoV2 infection has not been
proven.[9] On the contrary, we may speculate that
Umbrian PLWHs have been vigilant because they perceived themselves to
be at higher risk or that imposed social isolation could have found an
ally in the stigma related to HIV infection. It is still premature to
understand if that self-isolation has severely damaged the continuum of
care.
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