Multilevel Influences on HIV and Substance Use in a YMSM Cohort

Abstract: Critical and urgent COVID-19 research questions will be addressed by characterizing SARS-CoV-2 seroprevalence and symptom profile in a racially diverse cohort of substance-using YMSM at baseline and again 6 months later using a home-collected, quantitative assay for antibodies expected to neutralize SARS-CoV-2 infectivity in vitro. The following are the specific aims: (1) Characterize socio-behavioral risks of COVID-19 by testing hypotheses that: a. At time of wave 1 testing in summer 2020, SARS-CoV-2 seroprevalence and symptom rates will be higher among Black and Latinx than White participants. Subsequent seroconversion will also be greater among Black and Latinx substance-using YMSM RADAR participants. b. Substance use will be associated with increased seroprevalence and symptoms. Specifically, utilization of combustible or vaporized nicotine or cannabis products, as well as methamphetamine, will increase prevalence of SARS-CoV-2 infection. Use of these substances will also predict seroconversion over subsequent follow-up. c. Participants who report sharing of drug smoking/vaporizing paraphernalia since March 2020 will have an increased seroprevalence, over-and-above the effect of use alone, due to additional transmission risk from contact. Sharing paraphernalia at wave 1 will also predict seroconversion over subsequent follow-up. (2) Understand COVID-19 risks associated with systemic inflammation, HIV-associated factors, and declining anti-SARS-CoV-2 antibodies by testing hypotheses that: a. Systemic inflammation is associated with increased sero-prevalence/-conversion and symptoms. b. SARS-CoV-2 seroprevalence may differ between HIV-infected and HIV-uninfected participants, or with antiretroviral use as PrEP or treatment (ART), after controlling for systemic inflammation. c. Lower CD4 cell count (in people living with HIV) is associated with decreased anti-SARS-CoV-2 spike receptor binding domain (RBD) IgG quantity and/or duration. d. Lower quantity and/or loss of detectable anti-SARS-CoV-2 spike RBD IgG is associated with higher risk of SARS-CoV-2 reinfection (a second, separate episode of PCR positivity in a subsequent peak of cases).