Impact of COVID-19 on the Care of Patients With HIV Infection (preprint)

The COVID-19 pandemic and associated lockdown measures have been associated with substantial disruptions to health care services, including screening for human immunodeficiency virus (HIV) and management of people living with HIV (PLWH). Methods: Data from 3265 patients were examined in a retrospective cohort study. We compared outpatient follow-up for PLWH, the number of new patients, treatment adherence, hospitalizations, and deaths during the “pandemic period” (March 2020 to February 2021) to the “pre-pandemic period” (the equivalent timeframe in 2019) and the “post-pandemic period” (March to September 2021). Results: During the pandemic period, the number of new patients seen at the HIV clinic (116), as well as the requested viral load tests (2414), decreased significantly compared to the pre-pandemic (204 and 2831, respectively) and post-pandemic periods (146 and 2640, respectively)(p<0.01 for all the comparisons). However, across the three study periods, the number of drug refills (1385, 1330, 1411, respectively), the number of patients with undetectable viral loads (85%, 90%, 93%, respectively), and the number of hospital admissions among PLWH remained constant. Conclusions: Despite the COVID-19 pandemic impact, our findings show stability in the retention of clinical care, adherence to treatment, and viral suppression of PLWH, with no significant impact on hospitalization rates and all-cause mortality.

COVID-19 in HIV-Infected Individuals: Preliminary Results of a Prospective Cohort (preprint)

Background: Information about incidence, clinical characteristics and outcomes of HIV-infected individuals with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is scarce. We characterized individuals with coronavirus disease 2019 (COVID-19) among a cohort of HIV-infected adults regularly followed-up at an HIV clinic in Madrid, Spain, one of the most affected cities worldwide.Methods: In this observational study, we included all consecutive HIV-infected individuals who were diagnosed of suspected or confirmed COVID-19 as of April 14, 2020. Demographic, clinical, treatment, and laboratory data, including HIV-specific information, were extracted from the electronic health records. We compared the characteristics of HIV-infected individuals with COVID-19 with a representative sample of HIV-infected individuals evaluated before the COVID-19 pandemic (n=1,302), and described the evolution and outcomes of individuals with COVID-19 according to baseline characteristics.Findings: Thirty-seven HIV-infected individuals (mean, 53·5 years; females, 16%) were diagnosed with COVID-19 (incidence, 1·3%, 95% confidence interval: 0·9-1·8%). Of them, 29 (78%) were laboratory confirmed cases, and 26 (70%) required hospitalization. Overall, 29 (78%) individuals had comorbidities, predominantly hypertension and diabetes, higher than that observed among HIV-infected individuals without COVID-19 ( P =0·006). Additionally, a significantly higher percentage of individuals with COVID-19 were receiving tenofovir prior to COVID-19 diagnosis compared to HIV-infected individuals without COVID-19 (70% versus 52%, P =0·030), and the rate of prior protease inhibitor use was similar in both groups (mostly darunavir, 19% versus 18%, P =0·830). Clinical, analytical and radiological presentation of COVID-19 in HIV-infected individuals was similar to that described in the general population: five (14%) were critically-ill, and two (5%) died. Two out of five critically ill individuals had CD4+ counts <200 cells/mm3.Interpretation: Our findings indicate that COVID-19 predominantly affects HIV-infected individuals with comorbidities. These data do not suggest a protective effect of CD4+ count or previous antiretroviral therapy on the rate of infection or outcomes.Funding Statement: None.Declaration of Interests: MJPE has received research grants or honoraria for lectures or for participation in advisory boards from Abbott, Bristol-Myers Squibb, Boehringer Ingelheim, Gilead Sciences, ViiV-Healthcare previously GlaxoSmithKline, Roche, and Janssen; and unrestricted grants from Abbott, ViiVHealthcare previously GlaxoSmithKline, Gilead Sciences and Janssen. For the remaining authors, none was declared.Ethics Approval Statement: The study protocol was approved by our Institutional Review Board (EC 110/20), and patients provided oral informed consent in order to minimize staff exposure.