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Clin Infect Dis ; 2022 Mar 04.
Article in English | MEDLINE | ID: covidwho-1852995


BACKGROUND: After COVID-19 shelter-in-place (SIP) orders, viral suppression (VS) rates initially decreased within a safety-net HIV clinic in San Francisco, particularly among people living with HIV (PLWH) experiencing homelessness. We sought to understand if (1) proactive outreach to provide social services, (2) scaling up of in-person visits, and (3) expansion of housing programs could reverse this decline. METHODS: We assessed VS 24 months before and 13 months after SIP using mixed-effects logistic regression, followed by interrupted time series (ITS) analysis to examine changes in the rate of viral suppression per month. Loss to follow-up (LTFU) was assessed via active clinic tracing. RESULTS: Data from 1,816 patients were included, with a median age of 51 years, 12% were female, 14% experiencing unstable housing/homelessness. The adjusted odds of VS increased 1.34-fold following institution of the multi-component strategies (95% confidence interval (CI)=1.21-1.46). In the ITS analysis, the odds of VS continuously increased 1.05-fold per month over the post-intervention period (95% CI=1.01-1.08). Among PLWH previously experiencing homelessness who successfully received housing support, the odds of VS were 1.94-fold higher (95% CI=1.05-3.59). The one-year loss to follow-up rate was 2.8 per 100-person-years (95% CI=2.2-3.5). CONCLUSIONS: After an initial destabilization in VS following SIP orders, the VS rate increased following institution of the multi-component strategies, with a lower LFTU rate compared to prior years. Maintaining in-person care for underserved patients, with flexible telemedicine options, along with provision of social services and permanent expansion of housing programs, will be needed to support VS among underserved populations during the COVID-19 pandemic.

AIDS ; 35(15): 2545-2547, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1532623


To assess SARS-CoV-2 outcomes, we matched a municipal COVID-19 registry and clinic rosters from a municipal primary care network containing a large HIV clinic and assessed clinical outcomes by HIV status. The risk of severe COVID-19 was higher among people with HIV (PWH, adjusted relative risk = 1.84, 95% confidence interval = 1.05-3.25), while SARS-CoV-2 incidence was lower despite higher testing rates. SARS-CoV-2 vaccination campaigns should prioritize PWH to prevent severe COVID-19 disease given potentially higher risk.

COVID-19 , HIV Infections , COVID-19 Vaccines , HIV Infections/complications , Humans , Incidence , SARS-CoV-2
JAMA ; 324(16): 1651-1669, 2020 10 27.
Article in English | MEDLINE | ID: covidwho-865967


Importance: Data on the use of antiretroviral drugs, including new drugs and formulations, for the treatment and prevention of HIV infection continue to guide optimal practices. Objective: To evaluate new data and incorporate them into current recommendations for initiating HIV therapy, monitoring individuals starting on therapy, changing regimens, preventing HIV infection for those at risk, and special considerations for older people with HIV. Evidence Review: New evidence was collected since the previous International Antiviral (formerly AIDS) Society-USA recommendations in 2018, including data published or presented at peer-reviewed scientific conferences through August 22, 2020. A volunteer panel of 15 experts in HIV research and patient care considered these data and updated previous recommendations. Findings: From 5316 citations about antiretroviral drugs identified, 549 were included to form the evidence basis for these recommendations. Antiretroviral therapy is recommended as soon as possible for all individuals with HIV who have detectable viremia. Most patients can start with a 3-drug regimen or now a 2-drug regimen, which includes an integrase strand transfer inhibitor. Effective options are available for patients who may be pregnant, those who have specific clinical conditions, such as kidney, liver, or cardiovascular disease, those who have opportunistic diseases, or those who have health care access issues. Recommended for the first time, a long-acting antiretroviral regimen injected once every 4 weeks for treatment or every 8 weeks pending approval by regulatory bodies and availability. For individuals at risk for HIV, preexposure prophylaxis with an oral regimen is recommended or, pending approval by regulatory bodies and availability, with a long-acting injection given every 8 weeks. Monitoring before and during therapy for effectiveness and safety is recommended. Switching therapy for virological failure is relatively rare at this time, and the recommendations for switching therapies for convenience and for other reasons are included. With the survival benefits provided by therapy, recommendations are made for older individuals with HIV. The current coronavirus disease 2019 pandemic poses particular challenges for HIV research, care, and efforts to end the HIV epidemic. Conclusion and Relevance: Advances in HIV prevention and management with antiretroviral drugs continue to improve clinical care and outcomes among individuals at risk for and with HIV.

Anti-Retroviral Agents/therapeutic use , HIV Infections/drug therapy , HIV Infections/prevention & control , AIDS-Related Opportunistic Infections/drug therapy , Age Factors , Anti-Retroviral Agents/economics , Betacoronavirus , COVID-19 , Comorbidity , Coronavirus Infections/epidemiology , Drug Administration Schedule , Drug Costs , Drug Resistance, Viral/genetics , Drug Substitution/standards , Drug Therapy, Combination/methods , Female , HIV Infections/blood , HIV Infections/diagnosis , Humans , International Agencies , Male , Pandemics , Pneumonia, Viral/epidemiology , Polypharmacy , Pre-Exposure Prophylaxis/methods , Pregnancy , Pregnancy Complications, Infectious/drug therapy , RNA, Viral/blood , SARS-CoV-2 , Societies, Medical , United States , Viral Load/genetics