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Difference of SARS-CoV-2 infection and influence factors between people with and without HIV infection

成人头条 volume听25, Article听number:听386 (2025) Cite this article

Abstract

Background

There are mixed findings in the literature regarding the association between HIV status and the risk of COVID-19 infection. Thus, we aimed to estimate the association between characteristics of HIV infection and the risk of COVID-19 Infection in a Chinese sample.

Methods

We conducted a cross-sectional survey of 1995 people living with HIV (PLWH) and 3503 HIV-negative adults in Ningbo, China. We compared the prevalence rates of the SARS-CoV-2 infection and the long nucleic acid conversion time (more than 2 weeks) among PLWH and HIV-negative participants, respectively. In addition, we explored the risk factors associated with SARS-CoV-2 infection and the long nucleic acid conversion time among the two groups.

Results

Overall, 1485/1995 (74.4%) PLWH and 2864/3503 (81.8%) HIV-negative people were infected with SARS-CoV-2. Among the SARS-CoV-2-infected participants, 437/1485 (29.4%) PLWH and 649/2864 (22.7%) HIV-negative people had the long nucleic acid conversion time. After controlling for the potential confounders, the rate of the SARS-CoV-2 infection was lower among the PLWH than the HIV-negative group (adjusted OR鈥�=鈥�0.836, 95% CI鈥�=鈥�0.706鈥�0.990). However, PLWH had a significantly higher risk of the long nucleic acid conversion time after the SARS-CoV-2 infection (adjusted OR鈥�=鈥�1.417, 95% CI鈥�=鈥�1.176鈥�1.707) than the HIV negative participants. Compared with those who did not receive ART, PLWH adults who received ART significantly had the increased risk of SARS-CoV-2 infection. Furthermore, HIV-negative participants receiving COVID-19 vaccines significantly displayed the decreased likelihood of the long nucleic acid conversion time after the SARS-CoV-2 infection.

Conclusions

Our study indicates that different HIV Infection status was significantly and differently associated with the SARS-CoV-2 infection and the long nucleic acid conversion time. However, the further studies are needed to confirm the effect of ART and COVID-19 vaccines on SARS-CoV-2 infection in PLWH.

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Background

Given the high transmissibility of the latest Omicron subvariants of SARS-CoV-2 [1], a nationwide pandemic of the Omicron variant has been dominant in China. More than 90% Chinese locally-acquired cases belong to the BA.5.2 or BF.7 lineages [2]. It has been estimated that 60鈥�80% of people in major cities were infected in this major outbreak after ending of 鈥渮ero COVID鈥� strategy [3, 4]. Between 6 Dec, 2023 to 16 Jan, 2024 the number of infections with the Omicron variant in China surged by more than 80听million, and nearly 40,000 new confirmed deaths were reported during this period, according to WHO data [5]. In the case of Sichuan, the prevalence rate of COVID-19 was estimated to reach 74.34% between January 6 and 12, 2023, with most cases contracted with Omicron [6]. The similar result was also found in Beijing (75.7%) [7].

The body鈥檚 own infection status affects its susceptibility to COVID-19 infection. For example, numerous studies revealed that the risk of COVID-19 infection in tuberculosis patients was higher than general population, with longer time-to-recovery [8, 9]. Whether HIV status in people increases the risk of COVID-19 remains uncertain. Following the onset of COVID-19, several studies have been published on populations with immune perturbations from innate and adaptive immunity, such as people living with HIV (PLWH), chronic inflammation, and accelerated immune senescence. These studies found that a high prevalence of comorbidities and sociodemographic factors appeared to be related to an increased risk of COVID-related illness [10,11,12,13,14,15]. In contrast, other studies have not found HIV to be a risk factor for COVID-19 infection [16, 17]. In fact, some researchers believe that HIV status can play a protective role in the incidence of COVID-19 prevalence [18, 19]. Given the mixed evidence, the debate regarding HIV status being a risk factor for COVID-19 infection remains unresolved. Understanding the impact of HIV status on the incidence of COVID-19 prevalence is key to inform appropriate interventions aimed at preventing severe sequelae and to predict their future burden in vulnerable populations.

The cessation of China鈥檚 鈥渮ero-COVID鈥� strategy and the subsequent outbreak of the Omicron variant within the country presented us with a timely opportunity to investigate whether PLWH were more vulnerable to infection with the Omicron variant. Thus, in the present study, the primary objective was to explore the relationship between HIV status and prevalence rate of Omicron variant infection. Furthermore, the study aimed to identify the risk factors for the presence of this infection and for the long nucleic acid conversion time of the Omicron variant in PLWH and HIV-negative adults.

Methods

Study population

A cross-sectional survey was conducted in Ningbo, Zhejiang Province between 15 Jan, 2023 and 4 Feb, 2023. The sampling strategy in this survey was simple random sampling of (1) PLWH living in Ningbo from the HIV/AIDS Prevention and Control Information System of Chinese Disease Prevention and Control Information System, and (2) HIV-negative people from the general population living in Ningbo. All participants were contacted face-to-face to complete a self-administered questionnaire (This questionnaire was uploaded to supplementary material and see more details in it).

The inclusion criteria of this study involved participants who: (1) were aged鈥夆墺鈥�18 years old, and (2) understood the purpose and significance of this study and signed an informed consent form. The exclusion criteria were participants with severe physical illness/disabilities or mental disorders), or who did not sign an informed consent form. After excluding 219 (219/5717鈥�=鈥�3.8%) participants due to participants not providing complete information or not meeting the enrollment criteria, a total of 5498 (5498/5717鈥�=鈥�96.2%) participants were included in the final data analysis.

The study was approved by the Human Research Ethics Committee of Ningbo CDC in Ningbo, China (No. 201913). The study was conducted in accordance with the Declaration of Helsinki.2.2 Data collection.

Data collection and diagnose

Well-trained health-care assistants helped participants to complete a self-administered structured questionnaire, which included: (1) socio-demographic characteristics of individual (e.g., age, sex, marital status, race, education level), (2) the presence or absence of an underlying medical condition (i.e., hypertension, diabetes, chronic obstructive pulmonary disease, cardiovascular disease, chronic kidney disease, oncology/cancer, cerebrovascular disease and others), and the participants鈥� COVID-19 vaccination status (unvaccinated, or one/two doses, or three doses, or four doses [20]. SARSCoV-2 infection status between 7 Dec, 2022 and 15 Jan, 2023 (positive SARS-CoV-2 nucleic acid testing, or positive SARS-CoV-2 rapid antigen test, or uninfected). Based upon this question, positive SARS-CoV-2 nucleic acid testing or positive SARS-CoV-2 rapid antigen test was used as the standard diagnostic criterion for COVID-19 infection in this study.

Four questions were asked about the participants鈥� health behaviors following infection with the COVID-19: [1. Have you ever sought medical attention since you were infected with the COVID-19? (no, yes); 2. Have you been hospitalized since you were infected with the COVID-19? (no, yes); 3. Have you taken any of anti-COVID medications since you were infected with the COVID-19? (no, yes); 4. How many weeks did it take for your COVID-19 antigen or nucleic acid to turn negative? (less than 2weeks, more than 2 weeks)]. For the PLWH participants, data exported from the HIV/AIDS Prevention and Control Information System of Chinese Disease Prevention and Control Information System included antiretroviral therapy (ART) status (on ART, or none), recent CD4鈥�+鈥塗 lymphocyte count (CD4 count, (0鈥�199 cells/碌L, or 200鈥�349 cells/碌L, or 350鈥�499 cells/碌L, or 鈮モ��500 cells/碌L, or unknown)), and HIV viral load (HIV-VL, undetectable (<鈥�20 IU/ml), detectable (鈮モ��20 IU/ml), unknown).

Confounding variables

Based upon previous published literature, the following confounding variables were chosen: age, gender, marital status, race, education level, underlying medical conditions [21].

Statistical analysis

The means and standard derivation (SD) were calculated to describe the continuous variables, and frequencies with percentages were calculated to describe the dichotomous or categorical variables. Student鈥� t-tests or chi-square tests were used for comparing between PLWH and HIV-negative people. Binary logistic regression analyses were performed to evaluate the association between HIV-infected status and the presence of the COVID-19 after adjusting for the aforementioned covariates. To explore the potential risk factors for COVID-19 infection and positive duration in PLWH and HIV-negative people, we conducted multivariable logistic regression analysis in both different populations. All statistical analyses were performed in SPSS version 26路0 (IBM Corp, Armonk, New York, United States). All two-tailed p-values鈥�<鈥�0.05 were deemed statistically significant.

Results

Characteristics of participants

The comparison of socio-demographic characteristics between PLWH and HIV-negative people is presented in Table听1. The mean age of the PLWH participants (43.12 years, SD鈥�=鈥�13.4 years) was greater than the mean age for the and HIV-negative participants (40.92 years, SD鈥�=鈥�13.5 years). The frequency of males was significantly higher in PLWH compared with HIV-negative participants. There were more underlying diseases in the PLWH subgroup than HIV-negative subgroup. That is, significant differences between PLWH and HIV-negative participants were observed in term of gender, age, education level, marital status and underlying diseases.

Table 1 Baseline characteristics of the participating people with and without HIV infection
Full size table

Among PLWH, the prevalence for COVID-19 infection (74.4%) was significantly lower than in individuals without HIV (81.8%). Compared with HIV-negative participants, the proportion of three doses of COVID-19 vaccines was higher (62.8% vs. 50.0%), and the proportion of four doses of COVID-19 vaccination was significantly lower among PLWH (1.3% vs. 37.1%).

Among people infected with SARS-CoV-2 (4349), the proportion taking anti-COVID-19 medications and the hospitalization rate in PLWH were both higher than those in HIV-negative participants (76.3% vs. 57.8%, 1.2% vs. 0.5%). However, the rate seeking medical attention in HIV-positive participants was lower than in HIV-negative participants (16.7% vs. 21.6%). Furthermore, the proportion of individuals who had the COVID-19 antigen or nucleic acid turned negative for more than 2 weeks in PLWH was greater than that in HIV-negative participants (29.4% vs. 22.7%; see Table听2 for further details).

Table 2 Behaviors of the participants after COVID-19 infection
Full size table

Factors associated with SARS鈥慍oV鈥�2 infection among all participants

As illustrated in Fig.听1, adjusting for gender, age, marital status, race, education level and other chronic medical conditions, the risk of SARS鈥慍oV鈥�2 infection among PLWH was significantly lower compared with HIV-negative participants (with adjusted ORs ranging from 0.706 to 0.990). In contrast COVID-19 vaccination status was not significantly associated with risk of COVID-19 infection.

Fig. 1
figure 1

Factors associated with SARS-CoV-2 infection among PLWH and HIV-negative people (N鈥�=鈥�5498)

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Factors associated with long nucleic acid conversion time after SARS鈥慍oV鈥�2 infection among all COVID-19 patients

After controlling for the potential confounders, compared with HIV-negative participants, PLWH experienced a significantly higher risk of the long nucleic acid conversion time after the COVID-19 infection (adjusted OR鈥�=鈥�1.417, 95% CI鈥�=鈥�1.176鈥�1.707). Furthermore, participants who sought medical attention or hospitalized had an increased risk of the long nucleic acid conversion time after the COVID-19 infection, with adjusted ORs of 1.237 (95% CI鈥�=鈥�1.041鈥�1.471) and 2.491 (95% CI鈥�=鈥�1.202鈥�5.160), respectively. Compared with participants who did not vaccinate with COVID-19 vaccine, receiving one dose/two doses, or three doses of COVID-19 vaccines was protective against the risk of the long nucleic acid conversion time after the COVID-19 infection, with their adjusted ORs being 0.707 (95% CI鈥�=鈥�0.521鈥�0.959), and 0.747 (95% CI鈥�=鈥�0.579鈥�0.964), respectively. However, we did not find the significantly protective effect of receiving four doses of COVID-19 vaccines in COVID-19 patients. In addition, there was a non-significant association between taking anti-COVID-19 medications and the short positive duration after SARS鈥慍oV鈥�2 infection in all COVID-19 patients (Fig.听2).

Fig. 2
figure 2

Factors associated with the long nucleic acid conversion time among SARS-CoV-2 infected people (N鈥�=鈥�4349)

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Factors associated with SARS鈥慍oV鈥�2 infection or the long nucleic acid conversion time among PLWH

Figure听3 presents the results of the associations between a range of potential risk/protective factors and SARS鈥慍oV鈥�2 infection among PLWH after adjusting for potential confounders. Compared with the reference group of those PLWH who did not take ART, the likelihood of COVID-19 infection was significantly lower in PLWH who received ART (adjusted OR鈥�=鈥�0.557, 95%CI鈥�=鈥�0.351鈥�0.886). However, we did not find any significant associations between having different CD4 count, different HIV-VL or vaccinating three/four doses of the COVID-19 vaccines and the risk of SARS-CoV-2 infection.

Fig. 3
figure 3

Factors associated with SARS-CoV-2 infection among PLWH (N鈥�=鈥�1995)

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As illustrated in Fig.听4, among PLWH with COVID-19 infection, the only significant finding was that PLWH on ART experienced greater than 2 times the odds of the long nucleic acid conversion time compared with PLWH who were not on ART (adjusted OR 2.018, 95% CI鈥�=鈥�1.176鈥�3.466).

Fig. 4
figure 4

Factors associated with the long nucleic acid conversion time after SARS-CoV-2 infection among PLWH (N鈥�=鈥�1485)

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Factors associated with SARS鈥慍oV鈥�2 infection or the long nucleic acid conversion time among HIV-negative people

After controlling for the potential confounders, we did not find a significant association between COVID-19 vaccination status and the risk of SARS鈥慍oV鈥�2 infection in HIV-negative people (see Fig.听5).

Fig. 5
figure 5

Factors associated with SARS-CoV-2 infection among HIV-negative people (N鈥�=鈥�3503)

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As shown in Fig.听6, compared to those who never sought medical attention or hospitalized in HIV-negative people, participants who sought medical attention or hospitalized had significantly greater likelihood of being infected with COVID-19 (adjusted OR鈥�=鈥�1.446, 95% CI鈥�=鈥�1.176鈥�1.778; adjusted OR鈥�=鈥�3.067, 95% CI鈥�=鈥�1.029鈥�9.136). In contrast, compared with those who were not vaccinated against COVID-19, the likelihood of the long nucleic acid conversion time after COVID-19 infection was significantly lower in participants vaccinated with one/two doses (adjusted OR鈥�=鈥�0.411, 95% CI鈥�=鈥�0.243鈥�0.696), three doses (adjusted OR鈥�=鈥�0.450, 95% CI鈥�=鈥�0.286鈥�0.708), or four doses (adjusted OR鈥�=鈥�0.448, 95% CI鈥�=鈥�0.282鈥�0.713). However, there was no significant association between taking COVID-19 medications and the long nucleic acid conversion time after COVID-19 infection (see Fig.听6).

Fig. 6
figure 6

Factors associated with the long nucleic acid conversion time after SARS-CoV-2 infection among HIV-negative people (N鈥�=鈥�2864)

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Discussion

We explored the protective and risk factors associated with COVID-19 infection and the long nucleic acid conversion time in PLWH and HIV-negative populations following the Chinese government鈥檚 announcement of the ending of the 鈥渮ero COVID鈥� strategy. According to our review of the literature, our study might be the first such study to investigate these factors during this special period in China, conducted at a time when the Omicron variant of SAR-CoV-2 infection was the dominant strain [2, 22]. With a large sample size and adjustment for a range of covariates, we found a significant decrease in the risk of SARS-CoV-2 infection in PLWH compared with HIV-negative people. However, PLWH status was related to an increased risk of the long nucleic acid conversion time after SARS鈥慍oV鈥�2 infection compared to HIV-negative status. In addition, we found that ART might be a protective factor against SARS-CoV-2 infection in PLWH, but conversely a risk factor for long nucleic acid conversion time after SARS-CoV-2 infection in PLWH. Furthermore, we observed that vaccination with the COVID-19 vaccines significantly decreased the likelihood of the long nucleic acid conversion time after SARS-CoV-2 infection in HIV-negative people.

After the outbreak of COVID-19 in December 2019, researchers have explored the associations between HIV status and SARS-CoV-2 infection. A prospective cohort study among HIV clinics in 60 hospitals that served 77,590 PLWH in the Madrid region, found a lower age- and sex-standardized risk of COVID-19 infection among PLWH on ART than people without HIV [19]. Another prospective observational single-center cohort study including 5683 PLWH in Barcelona also found COVID-19 standardized incidence rate was lower in PLWH than in HIV-negative people [23]. Furthermore, amidst the evolving global pandemic landscape, the emergence of variants, coupled with the adjustments to the preventive and control policies implemented by the Chinese government, has led to the Omicron variant becoming the predominant strain in China鈥檚 post-epidemic era [2], Tan et al. conducted observational study in Wuhan, China and found that PLWH had a lower prevalence of COVID-19 infection than HIV-negative people [18], but they did not explore the factors associated the long nucleic acid conversion time after COVID-19 infection. During our research period (15 Jan, 2023 to 4 Feb, 2023), the SARS-CoV-2 infection strains detected by the Chinese CDC were all Omicron variants, including BA.5.2.48(53.9%), BF.7.14(25.2%) and BA.5.2.49(13.4%) [22]. Therefore, during the Omicron pandemic in China, our findings remain consistent with the above broader literature that shows that prevalence of SARS-CoV-2 infection in PLWH is lower than that in those without HIV. Possible explanations for this finding include: (1) PLWH have a lower rate of COVID-testing [24], (2) the number of COVID-19 cases among PWH may be underestimated due to a reluctance to access COVID-19 testing services [25, 26], (3) asymptomatic COVID-19 infection may be more common in PLWH than HIV-negative people [27, 28], and (4) ART could inhibit the SARS-COV-2 RNA polymerase and hence offer protection against infection and serious disease [19, 29].

However, previous epidemiological studies assessing PLWH and the risk of COVID-19 infection have also shown contradictory results [13, 15,16,17,18, 30,31,32]. A large meta-analysis conducted by Brolly et al. involving 22 studies comprising a pooled sample of 20听million patients across the world (including Europe, America, Africa and Asia) found a elevated risk of COVID-19 infection among PLWH (adjusted OR鈥�=鈥�1.24, 95%CI鈥�=鈥�1.05鈥�1.46) compared to HIV-negative people [30]. Also, a meta-analysis performed by SSENTONGO et al. found that HIV status was a significant risk factor for acquiring SARS-CoV-2 infection and was associated with a higher risk of mortality from SARS-CoV-2 [30]. Similarly, a recent cross-sectional study by Sachdev et al. in San Francisco demonstrated a higher incidence of SARS-COV-2 infection in PLWH [33]. Furthermore, other recent studies have found no significant increase in risk of COVID-19 infection in PLWH [15, 17, 32, 34]. For example, Berzosa et al. performed a prospective multicenter study in Madrid and analyzed data from children and adolescents living with HIV (CALWH). They revealed CALWH were not related to SARS-CoV-2 infection [32].

Potential explanations of the substantial inconsistencies in the findings from the above studies are probably due to: (1) differences in geographic factors [majority studies performed in developed countries, with low HIV prevalence and a high percentage of PLWH on effective ART]; (2) the emergence of new viral variants poses a challenge, as most studies were conducted at the inception of the SARS-CoV-2 pandemic in December 2019. However, China experienced a widespread outbreak of the Omicron variant, specifically the BA.5.2 and BF.7 lineages, following the cessation of the 鈥渮ero COVID鈥� strategy on November 1, 2022 [2]]; (3) changes in behaviors after ending suppressive measures [PLWH may be more cautious about the changing of COVID-19 prevention measures and know how to protect themselves than HIV-negative people]; (4) differences statistical power due to differences in sample size; (5) data source, different studies used different sources of data, different ways of obtaining data, and different methods of analysis. Taken together, further larger multicenter cohort studies with association between PLWH and SARS-CoV-2 infection in low incomes countries and developing countries are needed to explore the potential biological mechanisms and causal direction of this association more conclusively.

Another key finding from our study was that PLWH status was related to an increased risk of the long nucleic acid conversion time after SARS鈥慍oV鈥�2 infection. Our finding concurs with the findings from a study conducted in Henan province, China, that found that antibody turn negative time in PLWH was longer than in COVID-19 patients without HIV infection (32 days vs. 21 days) [35]. Similarly, a prospective cohort study conducted in South Africa found that PLWH were more likely to shed the virus (turn negative time) for longer compared with HIV-uninfected individuals [36]. Two potential reasons may have contributed to this finding. First, immunodeficiency might result in antibodies of PLWH clearing SARS-CoV-2 antibodies more slowly compared to HIV-negative individuals infecting with SARS-CoV-2 [37,38,39]. Second, PLWH infecting with SARS-CoV-2 might not exhibit typical immunodeficiency clinical symptoms due to impaired immunity [40, 41]. This may have increased their likelihood of being nucleic acid-positive asymptomatic infectors after SARS-CoV-2 infection, resulting in PLWH having little access to COVID-19 testing services.

Our study also observed that ART might be a protective factor against SARS-CoV-2 infection in PLWH, but conversely associated with an increased risk of the long nucleic acid conversion time after SARS-CoV-2 infection in PLWH. Previous studies have demonstrated that ART may have protective effects on SARS-CoV-2 infection in PLWH at the early onset of the COVID-19 pandemic outbreak [19, 29]. However, there has been emerging evidence that ART has not provided protection against COVID-19 infection among PLWH after COVID-19 spread throughout the world [23, 42, 43]. For instance, a cross-sectional survey performed by Wu et al. in Wuhan, China found no benefits of ART on SARS-CoV-2 infection among PLWH [43]. Furthermore, a review conducted by Natalia noted that there was no conclusive evidence for the efficacy of ART in the prevention of SARS-CoV-2 infection among PLWH, and that the disease course of COVID infection was longer in those receiving ART among PLWH [10]. Possible reasons for these contradictory results could be explained by the differences in sociodemographic factors, prevalence of comorbidities, HIV clinical parameters, the selection and evaluation of sociodemographic variables and history of comorbidities in participants and the time of the start of these studies. As such, caution is needed for the interpretation of the impact of ART in PLWH on SARS-CoV-2 infection or disease course; particularly following the emergence of the Omicron strain and the termination of the 鈥渮ero COVID鈥� strategy in China [22]. As such, prospective cohort studies with larger sample sizes conducted in China after December 7th, 2023 due to the ending of 鈥渮ero COVID鈥� strategy, are needed to fully confirm the effect of ART in PLWH on SARS-CoV-2 infection rates and disease course.

It is also of note that we did not find significant associations between HIV-related characteristics (CD4 count, HIV-VL) and the presence of COVID infection or the long nucleic acid conversion time. Our findings concur with the results from a study on PLWH in Mexico City that also found that SARS-CoV-2 infection in PLWH was not associated with HIV-associated clinical variables (CD4 count, HIV-VL) [44]. Similarly, several studies have consistently reported that neither the CD4 count nor HIV-VL are related to the SARS-CoV-2 infection in PLWH [23, 42, 45, 46]. Taking together, our results support the findings from these previous studies that HIV-related variables (CD4 count, HIV-VL) may have no effect on COVID infection or the long nucleic acid conversion time in PLWH.

Finally, we observed that vaccination with COVID-19 vaccines did not decrease the risk of COVID-19 infection in either group. This is in contrast to mounting evidence showing that the COVID-19 vaccination plays an important role in decreasing SARS-CoV-2 infection among PLWH and general population [47,48,49,50,51,52]. There may be several reasons for this finding: 1), inactivated vaccine protection against SARS-CoV-2 infection was decreased significantly after 6 months following primary vaccination [47, 53, 54]; 2), The Omicron variant, a specific strain of SARS-CoV-2, has demonstrated a potent immune escape capability, resulting in a decline in vaccine efficacy [55,56,57]; 3), the currently used COVID-19 vaccines are primarily designed to target the ancestral SARS-CoV-2 strain. Consequently, inactivated vaccine inoculations may not provide adequate protection against specific SARS-CoV-2 strains, including the Omicron variant, in China [58]. However, our study did show that COVID-19 vaccination could significantly decrease the likelihood of the long nucleic acid conversion time after SARS-CoV-2 infection only in HIV-negative people group. COVID-19 vaccines can significantly improve the Omicron serum antibody titer and the cellular immunity induced by antigen-specific CD8鈥�+鈥塗 cells [59, 60], and therefore further reduce the risk of long the nucleic acid conversion time after COVID-19 infection [61]. However, compared with general people, PLWH were at higher risk of severe COVID-19 outcomes [15, 17, 62]. This means that the time of nucleic acid conversion in PLWH would be longer even they received COVID-19 vaccines [35]. Therefore, longitudinal studies are needed to explore the differences in the impact of COVID-19 vaccines on the time of nucleic acid conversion time in PLWH and HIV-negative people, particularly in the aftermath of the Omicron variant outbreak in China.

The results of the present study should be interpreted in the context of its limitations. First, all participants were only recruited from Ningbo city, and may not be representative of the entire Chinese population and so indicate selection bias. Second, the data on the characteristics of COVID-19 infection was recalled by the participants using a self-report questionnaire, which might result in memory recall bias. Third, health behaviors such as smoking and drinking behaviors were not recorded, and therefore, we could not control for any possible confounding effect. Fourth, the cross-sectional nature of the study design limits any conclusions about the causal relationship of characteristics of HIV infection on COVID-19 infection. Fifth, socioeconomic factors such as occupation or income of participants were not collected in our study, which may influence the use of COVID tests, and the results of the multivariate analysis. Sixth, the differences in the frequency of hospital visits and the motivation to undergo testing between PLWH and the healthy control group may significantly affect the results. Seventh, we did not gather information from the participants regarding any previously diagnosed SARS-CoV-2 infections, which may potentially have a significant impact on the susceptibility to or progression of COVID-19.

Conclusion

In conclusion, the findings from our study suggest that PLWH have a lower prevalence of SARS-CoV-2 infection compared with a HIV-negative population, but may have an increased likelihood of the long nucleic acid conversion time after SARS-CoV-2 infection. We identified a protective effect of COVID-19 vaccination on the long nucleic acid conversion time only in those who were HIV-negative. Our findings warrant further investigation of the effect of HIV status on SARS-CoV-2 infection and the long nucleic acid conversion time, as well as differences in the role of COVID vaccines against COVID infection in HIV and HIV-negative populations.

Data availability

The data that support the findings of this study are available on request from the corresponding authors. The data are not publicly available due to privacy or ethical restrictions.

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Acknowledgements

The authors are grateful to all participants who participated in this research.

Funding

This study was supported by the Natural Science Foundation of Zhejiang Province (LQ20H260005), Key Medical Discipline of Zhejiang Province (07鈥�013), Medical and Health Science and Technology Program of Zhejiang Province (2020KY902), Key Discipline of Medicine of Ningbo Province (2022-B18), Science and Technology Program of Ningbo Public Welfare Science and Technology Program (2021S161), and Ningbo Top Medical and Health Research Program (No.2023020713).

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Author notes

  1. Feng Tong and Weiqing Chen contributed equally to this work.

Authors and Affiliations

  1. Ningbo Municipal Centre for Disease Control and Prevention, 1166 Fanjiang鈥檃n Road, Haishu District, Ningbo City, 315016, Zhejiang Province, PRC, China

    Jianhui Yang,听Dandan Zhang,听Haibo Jiang,听Kun Chu,听Shiwen Tan,听Zehao Ye,听Hongbo Shi听&听Feng Tong

  2. School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia

    Esben Strodl

  3. Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China

    Weiqing Chen

  4. Department of Information Management, Xinhua College, Sun Yat-sen University, No. 74, 2nd Yat-Sen Road, Yuexiu District, Guangzhou, Guangdong Province, PRC, 510080, China

    Weiqing Chen

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Contributions

JY, FT and WC conceptualized the study. DZ, HJ, KC, ZY and HS contributed to data collection. JH performed data analysis. JH, ES and WC wrote the manuscript. JY, ES, DZ, HJ, KC, ZY, HS, FT and WC critically reviewed the manuscript. All authors contributed to the study conception and design. All authors approved the final version of the manuscript. FT and WC as this manuscript the corresponding authors had final responsibility for the decision to submit for publication.

Corresponding authors

Correspondence to Feng Tong or Weiqing Chen.

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Ethics approval and consent to participate

The studies involving participants provided informed consent forms when they were enrolled. The study was approved by the Human Research Ethics Committee of Ningbo CDC in Ningbo, China (No. 201913). The study was conducted in accordance with the Declaration of Helsinki.2.2 Data collection.

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Not applicable.

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The authors declare no competing interests.

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Yang, J., Strodl, E., Zhang, D. et al. Difference of SARS-CoV-2 infection and influence factors between people with and without HIV infection. 成人头条 25, 386 (2025). https://doi.org/10.1186/s12889-025-21400-8

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  • DOI: https://doi.org/10.1186/s12889-025-21400-8

Keywords

成人头条

ISSN: 1471-2458

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