Seroprotection Against SARS-CoV-2 in Unvaccinated Children Living With HIV in North India: A Case Control Study

Background: The COVID-19 pandemic significantly affected vulnerable groups, particularly children living with HIV (CLHIV), many of whom remained unvaccinated.While anti-retroviral therapy (ART) can enhance immune function, its impact on the ability to respond to SARS-CoV-2 infection was not well understood.This study aimed to estimate the prevalence of anti-spike protein IgG antibodies against SARS-CoV-2 in unvaccinated CLHIV compared to healthy controls, providing insights into their immune response and informing public health strategies.Methodology: It was a case-control study, carried out in a pediatric anti-retroviral therapy (ART) centre of a tertiary hospital in Delhi, India, between April-September, 2022.CLHIV receiving ART and healthy controls, aged 18 months to 15 years were enrolled.Children with active infections other than COVID-19, those receiving immunosuppressive medications, other immunosuppressed conditions or those who were vaccinated against COVID-19 were excluded.Antibodies against SARS-CoV-2 were assessed by ELISA technique to ascertain seroprevalence. Results:We included 45 CLHIV receiving ART and 45 age-sex matched controls.Twenty-nine CLHIV (64.4%) and 37 (82.2%)controls had a reactive antibody index which was not significantly different.None of the HIV-or ART-related variables studied were significantly associated with seropositivity. Conclusion:Our study suggests that regular ART helps protect against severe COVID-19 infection by allowing CLHIV to mount an adequate antibody response even without COVID-19 vaccination.