Medication Non-Adherence and Condomless Anal Intercourse Increased Substantially During the COVID-19 Pandemic Among MSM PrEP Users: A Observational Longitudinal Study in Four Chinese Metropolises (preprint)

Background:  The coronavirus disease (COVID-19) pandemic has impacted HIV prevention strategies globally. However, changes in pre-exposure prophylaxis (PrEP) adherence and HIV-related behaviors, and their associations with medication adherence among MSM PrEP users remains unclear since the onset of the COVID-19 pandemic.  Methods:  A longitudinal observational study of HIV-negative MSM PrEP users was conducted in four Chinese metropolises from February to March 2020, assessing the changes in PrEP adherence and HIV-related behaviours before and during the COVID-19. The primary outcome was poor PrEP adherence determined from self-reported missing at least one PrEP dose in the previous month. We used mulitivariable logistic regression to determine factors correlated with poor adherence during the COVID-19. Findings:  We enrolled 791 eligible participants (418 [52·8%] in daily PrEP, 373 [47·2%] in event-driven PrEP). Compared with the data conducted before the COVID-19, the proportion of PrEP users decreased from 97·9% to 64·3%, and the proportion of poor PrEP adherence increased from 23.6% to 50·1% during the COVID-19 (odds ratio [OR] 3·24, 95% confidence interval (CI) 2·61–4·02). While the percentage of condomless anal intercourse (CAI) with regular partners (11·8% vs 25·7%) and with casual partners (4·4% vs 9·0%) both significantly increased. The proportion of those who were tested for HIV decreased from 50·1% to 25·9%. Factors correlated with poor PrEP adherence during the COVID-19 included not being tested for HIV (adjusted odds ratio [aOR]=1·38 [95% CI: 1·00, 1·91]), using condoms consistently with regular partners (vs. never, aOR=2·19 [95% CI: 1·16, 4·13]) and being married or cohabitating with a woman (vs. not married, aOR=3·08 [95% CI: 1·60, 5·95]). Interpretation:  Increased poor PrEP adherence and CAI along with the decrease in HIV testing can lead to increases in HIV acquisition and of drug resistance to PrEP. Targeted interventions are needed to improve PrEP adherence and HIV prevention strategies. Trial Registration: Chinese Clinical Trial Registry (ChiCTR-IIN-17013762). Funding Statement: The Mega-Projects of national science research for the13th Five-Year Plan (2017ZX10201101), the National Natural Science Foundation of China (81872674), and the National Science and Technology Major Project (2018ZX10101001-001-003). Declaration of Interests: We declare no competing interests. Ethics Approval Statement: This study was reviewed and approved by the Medical Science Research Ethics Committee of the First Affiliated Hospital of China Medical University ([2018]2015-139-5).

Effectiveness of Adjunctive Corticosteroid Therapy in Patients with Severe COVID-19: A Retrospective Cohort Study (preprint)

Objective: To investigate the effectiveness of adjunctive corticosteroid therapy in patients with severe COVID-19.Methods: We conducted a retrospective analysis of the difference in several outcomes between patients with severe COVID-19 who received corticosteroid therapy (the corticosteroid group) and patients with severe COVID-19 who did not receive corticosteroid therapy (the non-corticosteroid group).Results: Seventy-five patients were included in this study. Of these, 47 patients were in the corticosteroid group and 28 patients were in the non-corticosteroid group. There were no differences between the two groups in the total length of hospital stay (LOS), the length of ICU stay, high-flow oxygen days, non-invasive ventilator days, invasive ventilation days, and mortality rate. Total lesion volume ratio, consolidation volume ratio and GGO volume ratio in the corticosteroid group decreased significantly on day 14, while those in the non-corticosteroid group did not show a significant decrease.Conclusions: Our results show that adjunctive corticosteroid use did not significantly improve clinical outcomes in severe COVID-19 patients, but might promote the absorption of pulmonary lesions. Larger multicenter randomized controlled studies may be needed to confirm this.

High Acceptance of HIV Self-testing Among PrEP Recipients before COVID-19 Era: A Cross-sectional Analysis from PrEP Demonstration Project of MSM in China (preprint)

Background: Many Pre-exposure prophylaxis (PrEP) users have difficulty attending the quarterly facility-based HIV testing, which leads to the potential risk of drug resistance in the context of breakthrough infection with low drug compliance. We explored the acceptance of HIV self-testing (HIVST) service among PrEP recipients. Methods: MSM were recruited for the PrEP demonstration in four major cities in China from December 2018 to September 2019, provided with regimens of both daily and on-demand PrEP. Facility-based HIV testing was provided quarterly at clinic visits. Previous HIV testing history and acceptance of free HIVST kits to use between each quarterly clinic visit was collected. Correlates of levels of acceptance were analysed using multivariable ordinal logistic regression. Results: We recruited 1,222 MSM. among which 48.5% preferred daily PrEP and 51.5% preferred on-demand PrEP. There was 26.8% (321/1222) had never been to any facility-based HIV testing previously, and the self-reported major reason was that they had already routinely used HIVST. A quarter of the participants (74.5%, 910/1222) had used HIVST previously. There were 1184 MSM (96.9%) accepted to use HIVST between each quarterly clinic visits during PrEP usage, composing 947 ( 77.5%) very willing to, 237（19.4%）willing to, 29 (2.4%) unwilling to, and 9 (0.7%) very unwilling to. Participants preferred daily PrEP (vs. on-demand PrEP, aOR=1.8, 95% CI:1.3-2.4) and had less than 2 times of facility-based HIV testing in the past year (vs. ³2, aOR=1.4,95% CI:1.1-1.9) were more likely to have higher level of acceptance of HIVST.Conclusions: MSM had high acceptance of HIVST, especially among those preferred daily PrEP and with less facility-based HIV testing in the previous year. Offering HIVST services PrEP recipients is feasible and necessary. Above result is of great significance for promoting HIVST among PrEP users during COVID-19, improving awareness of their HIV infection status and ensuring compliance with medication. Future study should exam the impact of HIVST on HIV testing frequency among PrEP users.Trial registration: ChiCTR1800020374 on 27th Dec 2018. http://www.chictr.org.cn/searchproj.aspx

Antibody responses to SARS-CoV-2 in COVID-19 patients: the perspective application of serological tests in clinical practice (preprint)

Background We aim to investigate the profile of acute antibody response in COVID-19 patients, and provide proposals for the usage of antibody test in clinical practice. Methods A multi-center cross-section study (285 patients) and a single-center follow-up study (63 patients) were performed to investigate the feature of acute antibody response to SARS-CoV-2. A cohort of 52 COVID-19 suspects and 64 close contacts were enrolled to evaluate the potentiality of the antibody test. Results The positive rate for IgG reached 100% around 20 days after symptoms onset. The median day of serocon-version for both lgG and IgM was 13 days after symptoms onset. Seroconversion of IgM occurred at the same time, or earlier, or later than that of IgG. IgG levels in 100% patients (19/19) entered a platform within 6 days after seroconversion. The criteria of IgG seroconversion and [≥] 4-fold increase in the IgG titers in sequential samples together diagnosed 82.9% (34/41) of the patients. Antibody test aided to confirm 4 patients with COVID-19 from 52 suspects who failed to be confirmed by RT-PCR and 7 patients from 148 close contacts with negative RT-PCR. Conclusion IgM and IgG should be detected simultaneously at the early phase of infection. The serological diagnosis criterion of seroconversion or [≥] 4-fold increase in the IgG titer is suitable for a majority of COVID-19 patients. Serologic test is helpful for the diagnosis of SARS-CoV-2 infection in suspects and close contacts.