Incidence of COVID-19 among people living with HIV in Southern Spain

Abstract Objective and Design: The incidence of SARS-CoV-2 infection among people living with HIV (PLWH) has been estimated on the basis of reported symptomatic clinical cases. However, as asymptomatic cases are common and there have been limitations of health care systems for COVID-19 microbiological diagnosis, these estimations may be misleading. The availability of reliable serology for the diagnosis of COVID-19 may overcome this drawback. This study was carried out in order to reveal the actual incidence of SARS-CoV-2 infection in PLWH in Southern Spain.Methods: This is a prospective cohort study including HIV infected patients from the Unit of Infectious Diseases of a university hospital in Seville, Southern Spain. Patients were enrolled in the study if 1) they had attended the outpatient clinic from September 1st to December 31st, 2019 (baseline), and 2) had a subsequent evaluation from March 1st to June 30th, 2020 (intra-pandemic). Serum antibodies against SARS-CoV-2 were determined in baseline and intra-pandemic samples.Results: 326 patients were included in the study. Of them, 4 (1.25% [95% CI: 0.3%-3.1%]) developed COVID-19. One patient developed bilateral pneumonia and died. The remaining three showed mild respiratory symptoms suggesting COVID-19. No asymptomatic SARS-CoV-2 infection was observed in this study. No patient with COVID-19 was tobacco smoker. The incidence of COVID-19 among non-smokers was 2.5% (95% CI [0.6%-6%], p=0.057 versus smokers).Conclusions: The incidence of COVID-19 among PLWH in our area was low and similar to that observed in the general population. The frequency of asymptomatic cases might be lower than in patients without HIV infection. Tobacco smoking could be associated to a lower incidence of COVID-19.