Assessing the burden of Long-Covid in Persons with HIV using the RECOVER Research Index Restricted; Files Only
Dansby, Kamaria (Spring 2025)
Abstract
Some individuals recovering from COVID-19 experience persistent symptoms after the initial infection, a condition commonly referred to as Long Covid (LC). Persons with HIV (PWH), because of their immune dysregulation, are speculated to have an increased risk of LC. However, existing data are sparse and conflicting due to inconsistencies in the definition of LC. In this study, we used the RECOVER Research Index (RRI)22 to assess the burden and pattern of LC presentation in PLWH relative to persons without HIV (PWoH) who had a history of COVID-19 in the MACS/WIHS Combined Cohort Study (MWCCS).
We employed a descriptive study design, including MWCCS participants who self-reported a positive COVID-19 test between April 2020 and November 2023. Participants who completed the prospectively administered MWCCS COVID-19 survey, detailing persistent symptoms occurring between 30 and 365 days after COVID-19 infection, were included. LC was defined using the RRI, which weights 12 common LC symptoms according to strongest association with LC in the RECOVER cohort and sums the weights for a total score. Participants with total scores >=12 met criteria for LC. Among those with LC, we further characterized LC symptom-type by HIV status, sex, and COVID-19 vaccination status using chi-square tests.
Of 4,970 MWCCS participants, 1,616 (33%) reported a positive COVID test, 153 (10%) of whom met RRI criteria for LC. Among persons with LC, half were female, 63% were PWH, 37% were persons without HIV, and most (93%) had received at least 1 dose of COVID vaccine at time of study. Overall, the most common LC symptoms were post-exertional malaise (93%), chronic cough (94%), and loss of smell/taste (88%), while the least common LC symptoms were brain fog (28%), dizziness (19%), and palpitations (13%). There was no significant difference in LC symptom-type by HIV status. Neither sex nor vaccination status had measurable impact on LC prevalence or symptom-type in the study population.
Using the highly specific yet conservative RRI to define LC, PWH were similarly as likely as PWoH to develop LC after an acute COVID-19 infection with similar symptomatology. Our study is limited by the relatively small number of individuals with LC.
Table of Contents
TABLE OF CONTENTS
Background ………………………………………………………………………………………………1
Methods…………………………………………………………………………………………………...2
Results…………………………………………………………………………………………………….4
Discussion…………………………………………………………………………………………………7
References…………………………………………………………………………………………………10
Appendix………………………………………………………………………………………………......14
TABLES
Table 1. Baseline Demographic and Clinical Characteristics of participants in the MWCCS, by Long Covid Status between October 2022- September 2023……………………………………………………5
Table 2. Crude Prevalence of Long Covid and Median Long Covid score in MWCCS participants stratified by HIV serostatus…………………………………………………………………………………6
Table 3. Crude Prevalence of Long Covid in MWCCS participants stratified by gender identity…………6
Table 4. Crude prevalence of Long Covid as stratified by Covid-19 Vaccination Status of participants in the MWCCS……………………………………………………………………………………………….7
Table 5. Median age of participants in the MWCCS as stratified by Long Covid status…………………7
Table A1. Mapping of Symptoms in the RECOVER Research Index and the MWCCS Long Covid Symptom Questionnaire…………………………………………………………………………………...15
Table A2. Odd Ratio Estimates of Multivariable Logistic Regression Modeling Long Covid Status……17
Table A3. Type 3 Analysis of Effects from Multivariable Logistic Regression Modeling Long Covid Status ……………………………………………………………………………………………………17
FIGURES
Figure A1. RECOVER Research Index: Model-Selected symptoms that define Long Covid and their corresponding scores………………………………………………………………………………………14
Figure A2. Threshold for ruling in Long Covid as determined by the RECOVER Research Index……15
Figure A3. Long Covid symptom distribution as stratified by HIV serostatus in MWCCS participants..16
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