AIDS research and treatment · 2026
Effect of Antiretroviral Therapy, Immune Dysregulation, and COVID-19 Vaccination on SARS-CoV-2 Outcomes in PLWHA in Kenya.
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Njue James Kinoti, Wekesa Lihana, Maiyo Alex, Mwangi Zakayo Maingi, Kagendo Dorothy, Lwembe Raphael Mwamtsi
Аннотация
BACKGROUND: People living with HIV (PLWHA) may experience increased vulnerability to SARS-CoV-2 infection and severe COVID-19 due to immune dysregulation, comorbidities, and treatment adherence challenges. Kenya has over 1.4 million PLWHA. However, only a few have been reported with severe COVID-19, suggesting potential protective roles of antiretroviral therapy (ART), management of comorbidities, and COVID-19 vaccination.
METHODS: This study was conducted across high HIV-prevalence regions in Kenya (Nakuru, Malindi/Mariakani, and Kisumu). A cross-sectional survey evaluates clinical characteristics and self-reported COVID-19 vaccination outcomes among 303 PLWHA. Quantitative data were collected through structured questionnaires and clinical records. Associations between ART, immune markers (CD4/CD8 counts; viral load), COVID-19 vaccination, and SARS-CoV-2 infection and severity were tested using Chi-square and Fisher's exact tests.
RESULTS: An analysis of 303 participants (70.6% female, median age 40) revealed an 86.5% COVID-19 vaccination rate and 94.1% ART adherence. Only 9.2% reported prior SARS-CoV-2 infection, mostly mild, potentially indicating underreporting or asymptomatic cases. Interestingly, missing ART doses were significantly associated with contracting SARS-CoV-2 (p = 0.03). Furthermore, all participants reporting or demonstrating SARS-CoV-2 infection were vaccinated, compared to 85.1% of uninfected participants (p = 0.014). Due to incomplete health records, data for CD4 counts were available for only 7.6% of participants (n = 23), limiting conclusions regarding immune dysregulation.
CONCLUSION: Low COVID-19 rates were observed. All cases occurred in vaccinated participants, likely reflecting health-seeking bias rather than vaccine failure. Missing ART doses were significantly associated with infection. Optimal risk mitigation requires integrated strategies prioritizing both high vaccine coverage and strict ART adherence.
METHODS: This study was conducted across high HIV-prevalence regions in Kenya (Nakuru, Malindi/Mariakani, and Kisumu). A cross-sectional survey evaluates clinical characteristics and self-reported COVID-19 vaccination outcomes among 303 PLWHA. Quantitative data were collected through structured questionnaires and clinical records. Associations between ART, immune markers (CD4/CD8 counts; viral load), COVID-19 vaccination, and SARS-CoV-2 infection and severity were tested using Chi-square and Fisher's exact tests.
RESULTS: An analysis of 303 participants (70.6% female, median age 40) revealed an 86.5% COVID-19 vaccination rate and 94.1% ART adherence. Only 9.2% reported prior SARS-CoV-2 infection, mostly mild, potentially indicating underreporting or asymptomatic cases. Interestingly, missing ART doses were significantly associated with contracting SARS-CoV-2 (p = 0.03). Furthermore, all participants reporting or demonstrating SARS-CoV-2 infection were vaccinated, compared to 85.1% of uninfected participants (p = 0.014). Due to incomplete health records, data for CD4 counts were available for only 7.6% of participants (n = 23), limiting conclusions regarding immune dysregulation.
CONCLUSION: Low COVID-19 rates were observed. All cases occurred in vaccinated participants, likely reflecting health-seeking bias rather than vaccine failure. Missing ART doses were significantly associated with infection. Optimal risk mitigation requires integrated strategies prioritizing both high vaccine coverage and strict ART adherence.