Objective: Data on the impact of coronavirus disease 2019 (COVID-19) in people with HIV (PWH) are lacking in resource-constrained settings. We utilized existing randomized clinical trials (RCTs) on antiretroviral therapies (ART) in HIV-1 infection to conduct a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serosurvey, between January and March 2021, while characterizing participants' features.

Design: Cross-sectional serosurvey.

Methods: Demographic characteristics, medical history and a serum sample were collected from consenting PWH. Samples were analyzed centrally for immunoglobulin G antibodies to recombinant nucleocapsid and spike proteins derived from SARS-CoV-2 using a Luminex based assay.

Results: The 549 participants recruited in 9 sites across Africa had a median age of 40 years (interquartile range, IQR [34-45]); 63.0% (346) were female. All were on ART; 81.8% (449) had an HIV-1 viral load <50 copies/ml, with CD4 + cell count median at 478/mm 3 (IQR [320-677]). None had received vaccination against SARS-CoV-2. Forty participants (7.3%) had a prior SARS-CoV-2 PCR testing, of whom 10 were positive (1.8%). Crude SARS-CoV-2 seroprevalence was 36.2% (95% confidence interval (CI) [32.2-40.4]). In the explorative multivariable analysis, comparison of the characteristics of PWH with a positive SARS-CoV-2 serology with those with a negative or indeterminate serology: PWH with a body mass index (BMI) ≥30 kg/m 2 were more likely to have a positive serology than those with a BMI <25 (adjusted odds ratio (aOR) = 2.39 [1.48-3.86], P  < 0.001); and PWH living in Cameroon were less likely to have a positive serology.

Conclusion: This study demonstrates a substantial seroprevalence level of SARS-CoV-2 in PWH in the first quarter of 2021, with a marked disparity with the number of COVID-19 PCR tests reported positive.