ABSTRACT
Background: The COVID-19 pandemic resulted in disruptions to health care services. Vulnerable populations, including people living with HIV (PLHIV), may have experienced unique challenges when accessing medical care. The objective of this study was to evaluate the impact of social disruptions on health care visits among Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study (MWCCS) participants. Method(s): A survey collecting data on missed health care visits and social disruptions (i.e., disruptions in employment, childcare, financial support, housing, and health insurance) during the pandemic was administered via telephone to MWCCS participants 1-3 times from March and September 2020. Logistic regression models adjusted for sociodemographics and HIV-status were used to test the association between social disruptions and three medical care interruption outcomes (i.e., missed healthcare appointment, interruption of mental health care, and interruption of substance use care). Result(s): Surveys (n=10,076) were conducted among 2238 PLHIV (61% women) and 1427 people living without HIV (PLWoH) (41% women). Overall, 42% of participants reported disruptions in health care with no significant difference by HIV status. Among participants receiving mental health care services and substance use treatment, 52% and 36% reported interruptions of care, respectively. Participants reporting >= 2 social disruptions were more likely to report missed health care appointments (adjusted odds ratio [aOR]: 1.81, 95% confidence interval [CI]: 1.54-2.13), and interruptions in mental health care [aOR: 2.42, 95%CI: 1.85-3.17) or substance use treatment (aOR: 1.97, 95%CI: 1.26-3.09), compared to those reporting no disruptions. Participants who were unemployed were more likely to miss health care appointments (aOR:1.46, 95% CI: 1.25-1.71) and report disruptions in mental health care (aOR: 2.02, 95% CI: 1.54-2.66) compared to those who were employed. PLHIV reporting >= 2 social disruptions were at increased risk for missed health care appointments (aOR 1.92, 95%CI: 1.56-2.36) and disruptions in mental health care (aOR: 2.54, 95%CI: 1.83-3.53 (Table 1). Conclusion(s): Social disruptions as a result of the COVID-19 pandemic have adversely impacted the receipt of health care among PLHIV and PLWoH, including the receipt of treatment for mental health and substance abuse. Providing childcare, financial support, housing, and health insurance may reduce disruptions in care and improve health outcomes.
ABSTRACT
Background: COVID-19, the disease caused by SARS-CoV-2, has resulted in devastating morbidity and mortality worldwide. Alarming evidence indicates that long-term adverse outcomes of COVID-19 can affect all major systems of the body, including the immune, respiratory, cardiovascular, and neurological systems. While acute COVID-19 pathology does not appear to be markedly different by HIV status, long-term outcomes of COVID-19 in People with HIV (PWH) are unknown and require further investigation. This study evaluates the inflammatory profile longitudinally up to three months after COVID-19. In addition, markers of the blood-brain barrier (BBB) integrity and vascular dysfunction were also evaluated. Method(s): Plasma samples were collected from 15 males and 6 females with COVID-19 and HIV infection (COVID+/HIV+) and 9 males and 14 females with COVID-19 without HIV infection (COVID+/HIV-) between March 2020 and March 2021. Baseline samples were obtained approx. 10 days after COVID-19 diagnosis (T=0) and three months after (T=3). Mean age group for COVID+/HIV-was 45.4+/-17.8 years for males and 39.7+/-15.3 for females and for COVID+/HIV+ was 52.1+/-12.3 for males and 48.7+/-1 for females (N=15 and 6, respectively). 27 inflammatory molecules were measured by Bio-Plex Multiplex Immunoassay (Bio-Rad) and two markers of BBB and vascular dysfunction (soluble ICAM1 and S100beta) by ELISA. Result(s): Out of 27 inflammatory analytes, 20 had detectable signals. Eotaxin (CCL11) and G-CSF levels were differentially upregulated in the COVID+/HIV+ group as compared to the COVID+/HIV-group in both time point studied (Table 1). IFN-g showed sustained increased levels at T=3 in the COVID+/HIV+ group, whereas there was a significant reduction over time in the COVID+/HIV-group. At T3, inflammatory markers (IL-4, IL-8, IL-13, basic FGF, TNF-alpha, MIP-1alpha, and CCL2) either decreased or remained unchanged in both groups. In contrast, the markers of the BBB disruption and vascular dysfunction, such as S100beta and soluble ICAM-1 increased in the COVID+/HIV+ group, suggesting long-term progressive BBB and vascular alterations. Conclusion(s): HIV-1 may potentiate long COVID-19-induced neuropathology, with progressive BBB breakdown and sustained increase in eotaxin-1 and G-CSF. Plasma inflammatory markers in COVID-19 patients with or without HIV-1 co-infection.
ABSTRACT
Background: Women have reported increased menstrual irregularities during the COVID-19 pandemic. It is unknown if this is due to biological (i.e., the effect of SARS-CoV-2 infection or vaccination) and/or psychosocial factors. This study examined menstrual irregularities during the COVID-19 pandemic and the association of abnormal menses with the presence of SARS-CoV-2 antibodies, stress, and mental health among reproductive age women. Methods: A cross-sectional study of 182 HIV-negative, sexually active, 18-to 45-year-old cisgender women was conducted on biobehavioral factors influencing HIV risk. From January 2019 to September 2021, participants completed a survey of menstrual irregularities over the previous three months, previous month condomless vaginal intercourse, and plans to conceive. Starting October 2020, SARS-CoV-2 IgG antibodies were measured using an FDA EUA rapid test assay using whole blood, and participants completed the Centers for Epidemiological Studies Depression Scale, the Loneliness Brief Form, the Perceived Stress Scale. History of COVID-19 vaccination was self-reported. Menstrual irregularities were compared by recruitment date (pre-pandemic vs. during pandemic/after April 2020) and by IgG antibody status. Logistic regression models tested if the presence of antibodies was associated with menstrual irregularities when controlling for age (in all models) and stress, depression, and loneliness in separate models. Results: Key variables are illustrated in Table 1. Menstrual irregularities did not differ by enrollment date. About half of women (n=36) had detectable IgG;5 had been vaccinated. Controlling for age, women with detectable IgG had 7.3, 95% CI [1.5, 36.5], times the odds of menstrual irregularities. Neither age, stress, nor mental health were associated with irregular menstruation. Among unvaccinated women (n=31), 35% with IgG antibodies had irregular menstruation compared to 0% without IgG antibodies. Among women with no plans to conceive, 74% had condomless intercourse, of whom 11% had irregular menstruation. Conclusion: Findings suggest a relationship between SARS-CoV-2 infection and irregular menstruation that was not accounted for by stress or mental health. During the COVID-19 pandemic, increased condom use and routine pregnancy testing may be merited among women not intending to conceive.
ABSTRACT
Background. The Coronavirus disease of 2019 (COVID-19) global health crisis has resulted in an unprecedented strain on healthcare systems, reorganization of medical training programs and disruption in professional and personal lives of medical trainees. The impact of COVID-19 on infectious disease (ID) fellows, who are frontline healthcare professionals, has not been assessed. Methods. We conducted a national survey of adult and pediatric ID fellows to assess impact on educational activities, availability of personal protective equipment (PPE), well-being, and career prospects. Anxiety and burnout were assessed by 7-item generalized anxiety disorder scale and abbreviated Maslach burnout inventory respectively. Invitations to participate in the survey were sent via email to all ID fellows through Accreditation Council for Graduate Medical Education (ACGME) fellowship directors. Survey responses collected from August 1 to September 30, 2020 have been reported. Results. 136 fellows completed the survey (Table 1). 84% reported their institution had provided evidence-based didactics for management of COVID-19 and 53% indicated their general ID didactics were affected by the pandemic. 86% of fellows were involved in care of patients with COVID-19, and 31% reported a shortage of PPE affecting their clinical duties. Those living in highly impacted states (CA, FL, NY, TX) at the time of the survey were 1.70 times as likely to experience moderate to severe anxiety (vs. minimal to moderate) than those in other states;similarly, those who saw ≥11 COVID-19 patients weekly and reported PPE shortages were 2.5 and 2.0 times as likely, respectively, to experience moderate to severe anxiety compared to their peers who took care of 10 or fewer COVID-19 patients and did not experience PPE shortages. Burnout scores were not significant (Table 2). Conclusion. It is imperative that ID fellows feel adequately protected and supported during this pandemic. Pandemic preparedness should be included in the ID fellowship curriculum. Interventions for anxiety and burnout reduction should be implemented. ID fellowship programs should continue to accept feedback from fellows to ensure their ongoing safety, well-being, and education as we navigate this pandemic.
ABSTRACT
Severe viral pneumonia is a significant cause of morbidity and mortality globally, whether due to outbreaks of endemic viruses, periodic viral epidemics, or the rarer but devastating global viral pandemics. While limited anti-viral therapies exist, there is a paucity of direct therapies to directly attenuate viral pneumonia-induced lung injury, and management therefore remains largely supportive. Mesenchymal stromal/stem cells (MSCs) are receiving considerable attention as a cytotherapeutic for viral pneumonia. Several properties of MSCs position them as a promising therapeutic strategy for viral pneumonia-induced lung injury as demonstrated in pre-clinical studies in relevant models. More recently, early phase clinical studies have demonstrated a reassuring safety profile of these cells. These investigations have taken on an added importance and urgency during the COVID-19 pandemic, with multiple trials in progress across the globe. In parallel with clinical translation, strategies are being investigated to enhance the therapeutic potential of these cells in vivo, with different MSC tissue sources, specific cellular products including cell-free options, and strategies to 'licence' or 'pre-activate' these cells, all being explored. This review will assess the therapeutic potential of MSC-based therapies for severe viral pneumonia. It will describe the aetiology and epidemiology of severe viral pneumonia, describe current therapeutic approaches, and examine the data suggesting therapeutic potential of MSCs for severe viral pneumonia in pre-clinical and clinical studies. The challenges and opportunities for MSC-based therapies will then be considered.
ABSTRACT
Background: Immune dysfunction characterized by lower antibody (Ab) response to infection or vaccination has been well described among People Living with HIV (PLWH), but due to the novelty of the SARS-CoV-2 virus has not been evaluated among PLWH coinfected with SARS-CoV-2. This study compared the magnitude and longevity of Ab response to SARS-CoV-2 in a group of HIV+ and HIV-individuals infected with SARS-CoV-2 Methods: 17 HIV+COVID+ and 19 HIV-COVID+ participants were recruited from the community as part of the ACTION study and followed longitudinally at day 14, 1 month and 3 months. HIV+ were on effective ART (plasma viral load <500 copies/ml). SARS-CoV-2 infection was confirmed by SARS-COV2 DNA PCR and rapid antibody test. All participants had mild/moderate COVID-19 without hospitalization. Antibody responses (IgG and IgM) were measured using an indirect in house developed ELISA using spike RBD antigen (courtesy, Scott Boyd, Stanford University) and the data are expressed as relative Ab units based on the positive control standard. Results: The median age of HIV+ participants was 55 (26-63) with 23.5% (4/17) females. The median age for HIV-was 38 (27-78) with 57.8% (11/19) females. Time from COVID-19 diagnosis was 26 days for HIV+ and 21 for HIV-. Mean CD4 count for the HIV+ participants was 859.5 ± 287.2 cells/μl. Longitudinal analysis did not show a significant reduction in Ab response at 3 months in either HIV+ or HIV-groups. Levels of SARS-CoV-2 RBD specific IgM and IgG responses did not differ significantly between HIV+ and HIV-at any timepoint although there was a trend of lower IgM and IgG responses at 3 months in both groups compared to entry levels. Age was correlated with IgG response at day 14 (r =0.6, p = 0.02), 1 month (r =0.6, p = 0.014) and 3 month(r =0.87, p = 0.0008) in HIV+ and weakly correlated at day 14 (r =0.46, p = 0.04) in HIV-. Absolute CD4 count was not correlated with IgM and IgG responses in HIV+. Conclusion: The magnitude and persistence of Ab response to SARS-CoV-2 infection in the 3-4 months post-infection does not differ by HIV status. Although extended longitudinal follow-ups are required to gain insights about the longevity of Ab responses in HIV+ individuals, results suggest that immune protection and vaccine responses may not differ by HIV status.
ABSTRACT
STATEMENT: The International Society for Cellular and Gene Therapies (ISCT) and the International Society for Extracellular Vesicles (ISEV) recognize the potential of extracellular vesicles (EVs, including exosomes) from mesenchymal stromal cells (MSCs) and possibly other cell sources as treatments for COVID-19. Research and trials in this area are encouraged. However, ISEV and ISCT do not currently endorse the use of EVs or exosomes for any purpose in COVID-19, including but not limited to reducing cytokine storm, exerting regenerative effects or delivering drugs, pending the generation of appropriate manufacturing and quality control provisions, pre-clinical safety and efficacy data, rational clinical trial design and proper regulatory oversight.