Abstract
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.