ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2022
Prolonged Shedding of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at High Viral Loads Among Hospitalized Immunocompromised Persons Living With Human Immunodeficiency Virus (HIV), South Africa.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 1 of them a synthesis that pooled it.
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Who cites it
45 citing papers in PubMed, 1 synthesis or guideline pooled it, 64 citations in OpenAlex.
- Long COVID among people with HIV: A systematic review and meta-analysis.HIV medicine · 2025Pooled it
- Trial
- Transmission of mutated SARS-CoV-2 variants is favored by relatively prolonged infections due to delayed immunity.bioRxiv : the preprint server for biology · 2026Article
- Changing Prevalence of Immunocompromising Conditions in Patients Hospitalized with Severe Acute Respiratory Infection in Europe: Insights from the COVIDRIVE Study.Journal of epidemiology and global health · 2026Article
- Recurrent Cytopathic Effects and Prolonged Viral Shedding in an Immunocompromised Patient With Malignant Lymphoma Treated With Rituximab and Bendamustine: A Case of Coronavirus Disease 2019 Relapse.Clinical case reports · 2026Article
- Associations between serological evidence of SARS-CoV-2 infection and longitudinal pulmonary outcomes among people with HIV: analysis of the MACS/WIHS combined cohort study (MWCCS).Respiratory research · 2026Article
- Evolution and viral properties of the SARS-CoV-2 BA.3.2 subvariant.Virus evolution · 2026Article
- Exploring the Relationship Between Comorbidities and Prolonged Viral Shedding in COVID-19: A Cycle Threshold Value-Based Investigation.The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale · 2026Article
- HIV status is not associated with SARS-CoV-2 viral load and longer duration of infection among people with well-controlled HIV and high COVID-19 vaccine coverage.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2025Article
- Reduced Fc-mediated antibody responses after COVID-19 mRNA vaccination in a cohort of people living with HIV-1.Scientific reports · 2025Observational
- Intra-host SARS-CoV-2 diversity in immunocompromised people living with HIV provides insight into the evolutionary trajectory of SARS-CoV-2.Journal of virology · 2025Article
- Challenges in the Treatment of HIV-Related Lymphomas Complicated by COVID-19: Case Study and Review of the Literature.Pharmaceuticals (Basel, Switzerland) · 2025Review
- The consequences of SARS-CoV-2 within-host persistence.Nature reviews. Microbiology · 2025Review
- Hybrid versus vaccine immunity of mRNA-1273 among people living with HIV in East and Southern Africa: a prospective cohort analysis from the multicentre CoVPN 3008 (Ubuntu) study.EClinicalMedicine · 2025Article
- Virus Evolution in Prolonged Infections of Immunocompromised Individuals.Clinical chemistry · 2025Review
- Are older adults living with HIV more susceptible to omicron infection compared to their HIV-negative peers in China: a cross-sectional study.Frontiers in public health · 2025Article
- Dynamic contagion potential framework for optimizing infection control in healthcare.Frontiers in public health · 2025Article
- SARS-CoV-2 Ct values and COVID-19 symptoms in patients with haematological malignancies in South Africa.Southern African journal of infectious diseases · 2025Article
- How Immunocompromised Hosts Were Left Behind in the Quest to Control the COVID-19 Pandemic.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Article
- Characterisation of the antibody-mediated selective pressure driving intra-host evolution of SARS-CoV-2 in prolonged infection.PLoS pathogens · 2024Article
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Authors and funding
15 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundWe assessed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA shedding duration and magnitude among persons living with human immunodeficiency virus (HIV, PLHIV).
methodsFrom May through December 2020, we conducted a prospective cohort study at 20 hospitals in South Africa. Adults hospitalized with symptomatic coronavirus disease 2019 (COVID-19) were enrolled and followed every 2 days with nasopharyngeal/oropharyngeal (NP/OP) swabs until documentation of cessation of SARS-CoV-2 shedding (2 consecutive negative NP/OP swabs). Real-time reverse transcription-polymerase chain reaction testing for SARS-CoV-2 was performed, and cycle-threshold (Ct) values < 30 were considered a proxy for high SARS-CoV-2 viral load. Factors associated with prolonged shedding were assessed using accelerated time-failure Weibull regression models.
resultsOf 2175 COVID-19 patients screened, 300 were enrolled, and 257 individuals (155 HIV-uninfected and 102 PLHIV) had > 1 swabbing visit (median 5 visits [range 2-21]). Median time to cessation of shedding was 13 days (interquartile range [IQR] 6-25) and did not differ significantly by HIV infection. Among a subset of 94 patients (41 PLHIV and 53 HIV-uninfected) with initial respiratory sample Ct-value < 30, median time of shedding at high SARS-CoV-2 viral load was 8 days (IQR 4-17). This was significantly longer in PLHIV with CD4 count < 200 cells/µL, compared to HIV-uninfected persons (median 27 days [IQR 8-43] vs 7 days [IQR 4-13]; adjusted hazard ratio [aHR] 0.14, 95% confidence interval [CI] .07-.28, P < .001), as well as in unsuppressed-HIV versus HIV-uninfected persons.
conclusionsAlthough SARS-CoV-2 shedding duration did not differ significantly by HIV infection, among a subset with high initial SARS-CoV-2 viral loads, immunocompromised PLHIV shed SARS-CoV-2 at high viral loads for longer than HIV-uninfected persons. Better HIV control may potentially decrease transmission time of SARS-CoV-2.
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