Protective Effects of Antiretroviral Therapy against SARS-COV-2 Infections and COVID-19 Severity among PWH in Kenya

Raphael Mwamtsi Lwembe, Lihana Wekesa, Alex Maiyo, Mary Muyeku, Joseph Muriuki, Joseph Mwangi, Joyceline Kinyua, Sheila Kageha, Dama Olungae, Rency lel, Nancy Lagat, James Kinoti Njue, Collins Okoyo, Edward K Maina, Khamadi Ashimosi.

Abstract

People living with HIV (ILWH) are believed to be vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections due to their lowered immune system. Although antiretroviral therapy (ART) strengthens the body’s ability to fight infections, it has been hypothesised to reduce the severity of SARS-CoV-2. However, evidence remains inconsistent and limited in sub-Saharan Africa. We aimed to evaluate the potential protective effects of ART against SARS-CoV-2 infection and Coronavirus Disease 2019 (COVID-19) severity among PWH in Kenya. To achieve these, we designed a retrospective research study among 303 PWH receiving medical care at three selected HIV treatment facilities in Kenya. Medical records and Demographic information were mined from patient records and questionnaires. Descriptive statistics summarised participant characteristics, and associations between ART related variables obtained, immune markers, vaccination, and COVID-19 outcomes were analysed for statistical significance. Form the analysis, SARS-CoV-2 prevalence was detected in 9.2% (28/303) of the participants. Majority of the infected cases were mild (89.3%; 25/28), while 10.7% (3/28) were moderate, and severe case. SARS-CoV-2 status was less associated with ART regimen (p = 0.492), nor viral suppression (p = 0.484). However, missed ART doses showed a significant relationship with SARS-CoV-2 infection, which was relatively higher among infected participants (35.7%), compared to non-infected individuals (18.5%; p = 0.031). interestingly all infected participants were vaccinated. In our Conclusion, ART regimen did not show measurable protection against SARS-CoV-2 infection; however, non-adherence to ART increased infection risk, while COVID-19 vaccination showed reduced progression to severe disease. Ensuring ART adherence remains crucial for improving immune stability and strengthening pandemic resilience among PWH.