HIV and COVID-19: Intersecting Epidemics With Many Unknowns

Catherine R. Lesko; Angela M. Bengtson


Am J Epidemiol. 2021;190(1):10-16. 

In This Article

Surveillance for SARS-CoV-2 in PLWH

Strict initial guidance for testing for SARS-CoV-2 infection—restricting testing to people with a history of travel to Wuhan, and then to China, or to people with a known epidemiologic connection to a confirmed case—limits our ability to accurately describe incidence of SARS-CoV-2 in PLWH. Even if testing were widely available, incidence estimates would be plagued by nonrandomly missing data from people with poor access to health care, people who are avoiding health-care settings for fear of contracting or transmitting SARS-CoV-2, and people who do not believe themselves to be infected.

New serological assays for past exposure to SARS-CoV-2 are rapidly becoming available.[18] Sensitivity of serological tests in PLWH with compromised immune systems, who might not mount a vigorous antibody response, could be lower than the nominal sensitivity; unless test and patient characteristics are taken into account, serosurveys of PLWH might underestimate the true burden of SARS-CoV-2 infection. As with estimation of incidence, attempts to estimate prevalence of past SARS-CoV-2 infection in PLWH must take into account who is, and is not, included in any serosurvey. Some states are randomly sampling residents for serosurveys;[19] if sampling strategies considered groups of special interest, including PLWH, these serosurveys might be an opportunity to get estimates of prior SARS-CoV-2 infection in PLWH.