ABSTRACT
Background: The pandemic response measures have had significant global economic and health impacts with transient reductions in HIV clinic attendance and self-reported anti-retroviral therapy (ART) adherence reported in prior studies. Since viral suppression (VS) is an indication of ART adherence and effective service delivery, we assessed VS in the context of the COVID-19 pandemic in 3 African countries Methods: Since 2013, the African Cohort Study (AFRICOS) has enrolled individuals 18 years or older with and without HIV, in an approximate 5:1 ratio, at 12 clinics across 5 HIV care programs in Tanzania Uganda, Kenya, and Nigeria. For people living with HIV (PLWH), ART history was extracted from medical records and viral load was assessed at each visit. This assesses VS (< 1000 c/ml) before and during the COVID-19 pandemic (categorized into 4 surges and a consolidated non-surge period;defined in Table 1) among PLWH. Tanzania was excluded due to inadequate pandemic data. Logistic regression with generalized estimating equations, clustered by participant, was used to estimate odds ratios (ORs) and 95% confidence intervals (CI) comparing VS before and during COVID-19. Models are adjusted for age, sex, and program. Result(s): Of the 1741 study participants, 368 are from Uganda, 1156 are from Kenya, and 217 are from Nigeria;730 are males, 1011 are females, and 147 are under the age of 30. PLWH were less likely to be virally suppressed during the first surge period (OR 0.85, CI 0.46-1.56), but VS significantly increased during the second surge period (OR 1.95, CI 1.23-3.04) compared to the pre-COVID period. The third and fourth surge periods also saw a higher VS (table 1). Females are more likely to be virally suppressed than males (OR 1.58, CI 1.09- 2.29) and PLWH ages 40-49 have higher VS (OR 2.43, CI 1.32-4.48) compared to PLWH under. PLWH at the AFRICOS sites in Kenya and Nigeria show lower VS than the Ugandan cohort (ORs 0.46, CI 0.26-0.79 and OR 0.32, CI 0.17-0.60 respectively). Conclusion(s): The initial drop in VS may be attributed to reduced clinic access due to lockdowns. Many HIV programs supported by the President's Emergency Plan for AIDS Relief (PEPFAR) adapted their strategies to serve PLWH by scaling up community ART dispensing and multi-month dispensing (MMD) of ART for stable clients, which could have led to increased VS during the other surge periods.
ABSTRACT
Background: Recent findings from the UK Biobank revealed that healthy adults who later became infected with SARS-CoV-2 had lower brain volumes in regions involved in risk-taking behavior and olfaction compared to individuals who did not become infected. We examined if similar pre-existing differences in brain regions correspond to SARS-CoV-2 infection among people with HIV (PWH) receiving suppressive ART. Method(s): Participants included adult Thai MSM enrolled in the acute HIV (AHI) cohort (RV254/SEARCH010) in Bangkok, Thailand. Participants underwent 3T MRI and clinical assessments (i.e., HIV disease metrics, cognitive testing, and self-reported mood and substance use). ART initiation occurred within 5 days of the MRI (median=same day). Regional brain volumes were summed across hemispheres and corrected for head size. Brain volumes and clinical indices were compared between participants with laboratory confirmed SARS-CoV-2 and those without a diagnosis of SARS-CoV-2 following ART initiation. Machine learning was utilized to identify variables at the time of enrollment into the cohort that predicted subsequent SARS-CoV-2 infection status. Result(s): 112 participants were included in the analysis. All study participants achieved viral suppression after ART and received SARS-CoV-2 vaccinations. Fifty-four participants became infected with SARS-CoV-2 during the observation period (median=79 weeks from ART initiation). Study participants who became infected with SARS-CoV-2 after ART had lower volumes at the time of enrollment in several subcortical brain regions with the most pronounced effect in the pallidum (p=.025). There were no associations between brain volumes and ratings of mood, demographics, or HIV disease indices. SARS-CoV-2 infection was two-fold higher among individuals who reported use of amyl nitrites (i.e., poppers) during chemsex. Machine learning with repeated cross validation revealed that lower orbital and medial frontal lobe, anterior cingulate, pallidum, vermis, and olfactory volumes, worse motor function, and higher education collectively predicted co-infection status (average AUC of 85%). Conclusion(s): Study findings point toward a risk phenotype for SARS-CoV-2 infection among PWH defined by pre-existing differences in brain volumes relevant to risk-taking behavior, emotion, and neuroHIV as well as behavioral factors such as inhalant use and lack of social distancing during chemsex. (Table Presented).
ABSTRACT
Background: Pre-existing coronavirus-specific antibody responses may affect SARS-CoV-2 responses. We evaluated longitudinal samples obtained before and during the pandemic in participants from Kenya, Nigeria, Tanzania and Uganda;90% were people living with HIV. Method(s): Serum samples were tested using a multiplex bead-based immunoassay to measure antibody binding against 22 antigens including Nucleocapsid (N) and Spike (S) proteins of the 7 human coronaviruses and one malaria antigen. Result(s): We tested 819 longitudinal samples from 80 participants collected between July 2013 and May 2021 (3-16 samples per participant). Using a signal to noise ratio (S/N) >10, 13, 1, and 5 participants showed at least one time point with IgG responses to S of SARS-CoV-2 (ancestral), SARS-CoV-1 and MERS-CoV respectively while 14, 8, and 11 participants showed responses to N before 2020. Across individuals, IgG binding to SARS-CoV-2 S subunit S2 was most frequently detected and it showed the highest within-host fluctuations over time. A few individuals had elevated responses that persisted over years towards multiple antigens, most frequently to different SARS-CoV-2 antigens and rarely to distinct viruses. One individual showed high RBD-specific IgG responses to distinct coronaviruses at a single time point before 2020. Responses against coronaviruses measured post-2020 generally correlated with responses measured before 2020, except for a subset of infected individuals whose responses against SARS-CoV-2 dramatically increased post-pandemic. IgG responses against the ancestral SARS-CoV-2 variant were most correlated with responses against Alpha and Gamma (then to Beta and Delta, rho >0.75) variants. Using an IgM S/N >10, 31 participants were Malaria positive and 22 showed concurrent elevated coronavirus IgM responses. However, about half of the malaria positive participants had no IgG responses against any coronavirus antigen and the rest presented limited and variable patterns of association between responses against coronaviruses and malaria. Conclusion(s): Our study confirmed that a small subset of individuals in Africa had long-lasting IgG coronavirus-specific antibodies before the pandemic. While there was an association between coronavirus IgM responses and responses against malaria, there was no correlation between IgG responses and malaria infection. Further analysis is needed to better understand the interactions between antigens in the development of antibody immunity to coronaviruses. (Table Presented).
ABSTRACT
Background. Multi-month dispensing (MMD) of antiretroviral therapy (ART) decreases logistical burdens on HIV clinics and patients, which is especially important during the COVID-19 pandemic. HIV programs are scaling-up 6-month dispensing (6MD), but the impact on viral suppression (VS) has not been well-documented in programmatic settings. Methods. The African Cohort Study (AFRICOS) is an international observational study of people living with HIV (PLWH) receiving HIV care. In Nigeria and Kenya, this includes 6MD. Participants undergo semiannual viral load quantification and were included in analysis if they had complete data, documentation of MMD (self-reported) and at least two follow-up visits after initiating MMD. In stratified analyses for each country, we used multivariable logistic regression with generalized estimating equations to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) comparing VS < 50 copies/mL among those who received 6MD to those given 3-5 months dispensing (3-5MD) of ART. Analyses were adjusted for age, education, employment, distance to clinic, duration on ART, ART regimen (TLD vs other) and self-reported ART adherence (>= 1 missed dose in past 30 days). Results. Between January 30, 2020, when MMD data was first collected, and September 1, 2021, 1176 PLWH in Kenya and 272 in Nigeria had at least one visit;285 participants from Kenya, totaling 442 visits, and 177 participants from Nigeria, totaling 382 visits, met criteria and were included in analysis. At most recent visit, VS < 50 copies/mL was documented in 266 (93.3%) participants from Kenya and 125 (70.6%) participants from Nigeria. Among the 35 participants given 6MD in Kenya, compared to 250 participants given 3-5MD, the aOR for VS was 0.42 (95% CI: 0.13-1.37);among the 91 participants given 6MD in Nigeria, compared to the 86 participants given 3-5MD, the aOR was 3.01 (95%CI: 1.70-5.31). Conclusion. The positive association between 6MD and VLS in Nigeria, as compared to 3-5MD, should prompt more aggressive scale-up of 6MD. The lack of an association in Kenya merits further investigation, but likely relates to high overall VS and few participants on 6MD. Updated data from specific geographic and demographic sub-populations is needed to inform programming as 6MD is scaled.
ABSTRACT
The COVID-19 pandemic reached the African continent in less than three months from when the first caseswere reported from mainland China. As COVID-19 preparedness and response plans were rapidly instituted across sub-Saharan Africa, many governments and donor organizations braced themselves for the unknown impact the COVID-19 pandemicwould have in under-resourced settings with high burdens of PLHIV. The potential negative impact of COVID-19 inthese countries is uncertain, but is estimated to contribute both directly and indirectly to the morbidity and mortality ofPLHIV, requiring countries to leverage existing HIV care systems to propel COVID-19 responses, while safeguarding PLHIVand HIV programme gains. In anticipation of COVID-19-related disruptions, PEPFAR promptly established guidance to rapidlyadapt HIV programmes to maintain essential HIV services while protecting recipients of care and staff from COVID-19. Thiscommentary reviews PEPFARs COVID-19 technical guidance and provides country-specific examples of programme adaptionsin sub-Saharan Africa.