Subject(s)
COVID-19 , HIV Infections , Bayes Theorem , Comorbidity , HIV Infections/epidemiology , HumansABSTRACT
As a result of the COVID-19 pandemic, HIV care and prevention efforts have been disrupted. We investigated pre-exposure prophylaxis (PrEP) use and testing behaviors among MSM in the Netherlands, and the factors that influenced testing behaviors during the COVID-19 pandemic. A cohort of 766 MSM, established in 2017, was asked in August 2020 to report on their experiences during the COVID-19 pandemic via an online survey. Participants (n = 319) reported increased PrEP use and, among PrEP users (n = 211), significantly lower rates of having tested in the last 3 months for HIV and renal functioning compared to before the pandemic. Daily PrEP use and a higher number of sexual partners during the pandemic was significantly associated with continued HIV testing. Continued renal functioning testing was associated with older age. Correcting for pandemic-related disruptions in PrEP use and care will require sustained effort to understand and address missed opportunities.
RéSUMé: Como resultado de la pandemia de COVID-19, los cuidados y esfuerzos de prevención de VIH han sido interrumpidos. Investigamos el uso de la profilaxis preexposición (PrEP) y el comportamiento de diagnóstico de HSH en los Países Bajos y los factores de influencia durante la pandemia. Una cohorte de 766 HSH, establecida en 2017, reportó en agosto 2020 sus experiencias mediante una encuesta en línea. Los participantes (n = 319) reportaron un incremento en el uso de PrEP y, entre los usuarios de PrEP (n = 211), tasas menores de pruebas de VIH y funcionamiento renal comparado con tasas pre-pandemia. El uso diario de PrEP y un número mayor de parejas sexuales en pandemia fue asociado con la solicitud continua de pruebas de VIH. La solicitud continua de pruebas de funcionamiento renal fue asociada al incremento de edad. Un esfuerzo constante será necesario para corregir las interrupciones del uso y cuidado asociado a la PrEP.
Subject(s)
COVID-19 , HIV Infections , Pre-Exposure Prophylaxis , Sexual and Gender Minorities , Communicable Disease Control , HIV Infections/drug therapy , HIV Infections/epidemiology , HIV Infections/prevention & control , Homosexuality, Male , Humans , Male , Netherlands/epidemiology , Pandemics/prevention & controlABSTRACT
INTRODUCTION: The SARS-CoV-2 virus can currently pose a serious health threat and can lead to severe COVID-19 outcomes, especially for populations suffering from comorbidities. Currently, the data available on the risk for severe COVID-19 outcomes due to an HIV infection with or without comorbidities paint a heterogenous picture. In this meta-analysis, we summarized the likelihood for severe COVID-19 outcomes among people living with HIV (PLHIV) with or without comorbidities. METHODS: Following PRISMA guidelines, we utilized PubMed, Web of Science and medRxiv to search for studies describing COVID-19 outcomes in PLHIV with or without comorbidities up to 25 June 2021. Consequently, we conducted two meta-analyses, based on a classic frequentist and Bayesian perspective of higher quality studies. RESULTS AND DISCUSSION: We identified 2580 studies (search period: January 2020-25 June 2021, data extraction period: 1 January 2021-25 June 2021) and included nine in the meta-analysis. Based on the frequentist meta-analytical model, PLHIV with diabetes had a seven times higher risk of severe COVID-19 outcomes (odd ratio, OR = 6.69, 95% CI: 3.03-19.30), PLHIV with hypertension a four times higher risk (OR = 4.14, 95% CI: 2.12-8.17), PLHIV with cardiovascular disease an odds ratio of 4.75 (95% CI: 1.89-11.94), PLHIV with respiratory disease an odds ratio of 3.67 (95% CI: 1.79-7.54) and PLHIV with chronic kidney disease an OR of 9.02 (95% CI: 2.53-32.14) compared to PLHIV without comorbidities. Both meta-analytic models converged, thereby providing robust summative evidence. The Bayesian meta-analysis produced similar effects overall, with the exclusion of PLHIV with respiratory diseases who showed a non-significant higher risk to develop severe COVID-19 outcomes compared to PLHIV without comorbidities. CONCLUSIONS: Our meta-analyses show that people with HIV, PLHIV with coexisting diabetes, hypertension, cardiovascular disease, respiratory disease and chronic kidney disease are at a higher likelihood of developing severe COVID-19 outcomes. Bayesian analysis helped to estimate small sample biases and provided predictive likelihoods. Clinical practice should take these risks due to comorbidities into account and not only focus on the HIV status alone, vaccination priorities should be adjusted accordingly.