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Background: With NHS PrEP now available for those at risk, we aimed to identify missed opportunities for people newly diagnosed with HIV who attended sexual and reproductive health (SRH) services, and to determine the HIV outcomes associated with people acquiring HIV with previous or recent PrEP use. Method(s): A retrospective observational study reviewed all new HIV diagnoses from the last 2 years to see if they were eligible for PrEP and offered in SRH services. Data was collected using electronic medical records on HIV outcomes - virological suppression, resistance and antiretroviral choice. Result(s): There were 74 new HIV diagnoses. 41 people were eligible but only 10 were known to have accessed PrEP at our services. 21% were heterosexual and of black ethnicity - it was not possible to ascertain whether they were eligible for PrEP from the notes. Of the 10 people with recent PrEP use, 2 stopped due to side effects;headaches, vomiting, fatigue and renal toxicity concerns. For the remaining adherence concerns were reported - taking event based dosing (EBD) incorrectly and difficulty accessing services. 80% of people achieved virological suppression. 90% were put on a second generation integrase or protease inhibitor. No one developed nucleoside reverse transcriptase inhibitor (NRTI) resistance. 6 people eligible for PrEP had attended SRH services but not given PrEP. 2 attended during the IMPACT trial being full and referred to IwantPrEPnow. 2 attended during COVID where baseline bloods were done with follow up but subsequently tested positive. 2 people refused PrEP with 1 deeming themselves to be low risk. Conclusion(s): Our data highlights several missed opportunities for starting same-day PrEP which potentially may have prevented HIV acquisition. If PrEP is not issued on the day, adequate follow up must be ensured. Reassuringly those who acquired HIV with recent PrEP use have achieved good virological control without NRTI mutations. Counselling on potential side effects, EBD dosing and ongoing HIV risk are essential. Despite NHS PrEP available over 2 years, our data shows we are still failing to meet the demand of PrEP not only in men who have sex with men but also in other key at risk groups.
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The global pandemic of coronavirus infection (COVID-19) has set complex diagnostic tasks for doctors of polyclinics and hospitals. Considering the simultaneous pandemic spread of two infectious diseases - COVID-19 and HIV infection, the problem of studying the clinical features of combined COVID-19/HIV infection becomes urgent. The aim of the study was to determine the features of the diagnosis and course of COVID-19 against the background of HIV infection in patients undergoing inpatient treatment. Material and methods. The study was conducted on the basis of the temporary Clinical Medical Center COVID-19 of the A.I. Yevdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of the Russian Federation in Moscow from October 2020 to January 2022. The study included 31 233 patients with COVID-19 complicated by pneumonia. To analyze the features of the course of combined COVID-19/HIV infection, a group of 51 HIV-infected patients was identified. The diagnosis of COVID-19 was determined based on the detection of SARS-CoV-2 RNA by PCR in nasal/oropharyngeal smears and/or according to computed tomography of the lungs (CT). During the study, age, gender, anamnesis, objective examination data were analyzed, taking into account the results of CT scans of the chest organs, data from routine laboratory blood tests, oxygen support regimens, treatment outcomes and duration of detection of SARS-CoV-2 RNA. All patients were treated according to the Temporary Clinical Guidelines for the Diagnosis and Treatment of COVID-19, 14 version dated 12/27/2021. Results. The number of patients with combined HIV infection and SARS-CoV-2 out of the total number of hospitalized COVID-19 patients (n=31 233) was 0.16%. Upon admission, 30 (59%) patients reported having HIV infection and receiving antiretroviral therapy (ART). HIV infection was first diagnosed in 21 patients at 2-3 weeks of inpatient treatment. The average age of patients with SARS-Cov-2/HIV co-infection was 1.5 times less than in patients without HIV (41.1+/-5.3 and 64.4+/-10.1, respectively) (p<=0.05). Concomitant pathology (hypertension, type 2 diabetes mellitus, chronic kidney disease and chronic lung diseases) was less common (51%) in the group of combined infection than in the group without HIV (83%). However, in 41% of patients with coinfection, chronic viral hepatitis B, C was detected, in contrast to 0.3% of cases of COVID-19 patients without HIV. 26 (51%) patients were discharged with improvement, while the average bed-day did not differ from patients without HIV infection (13.4+/-4.5 days and 11.7+/-5.2, respectively) (p>=0.05). 7 (24%) patients at the time of discharge (16.8+/-4.2 days) with clinical and laboratory improvement maintained a positive result of PCR RNA on SARS-Cov-2. In 22 (43%) patients with coinfection, hospitalization was fatal for 3 to 21 days of treatment, with ARDS with respiratory and multiple organ failure, which is 3.6 times higher than in patients without HIV infection. The analysis showed that, regardless of the result of PCR on SARS-CoV-2 RNA, in non-specialized hospitals, HIV testing is indicated for young patients with fever for more than 14 days, with lung damage in the form of bilateral interstitial changes according to CT, a history of chronic hepatitis C, B, with progressive severity of the condition on against the background of COVID-19 therapy. Early consultation of an infectious disease specialist, examination of sputum/lavage by PCR for pathogens of opportunistic infections and the appointment of ART and drugs for the treatment of opportunistic diseases will improve the quality of medical care for patients in a non-core HIV hospital will improve the prognosis of COVID-19.Copyright © Eco-Vector, 2022.
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Background: Immune responses to SARS-CoV-2 vaccines in people living with HIV (PLWH) have been the focus of several recent studies. As the gut microbiome can influence vaccine immunogenicity, in this study we are the first to investigate whether the baseline gut microbiota can predict immune responses to the BNT162b2 SARS-CoV-2 vaccine in people living with HIV (PLWH) and healthy controls (HC). Method(s): Fecal samples were collected from PLWH (n=68) and HC (n=75) at baseline, prior to the first vaccine dose, to extract DNA for 16S rRNA sequencing. The individuals were part of the COVAXID Clinical trial, where humoral and cellular responses to SARS-CoV-2 vaccine were evaluated on day 35 after the first dose. Comprehensive bioinformatic tools were used for bacterial identification to further reveal the associations between gut microbiota and SARS-CoV-2 antibody, spike CD4+ T cell responses, and clinical parameters such as age, gender, CD4/CD8 ratio, and length of antiretroviral (ART) treatment. Result(s): At day 35 post vaccination, HC showed significantly higher spike IgG titers than PLWH (p=0.0001). Interestingly, both phylogenetic and alpha-diversity were negatively correlated with antibody titers, in the whole cohort and within groups. Similarly, individuals with low alpha-diversity had higher levels of spike specific CD4+T-cell responses. Agathobacter, Lactobacillus, Bacteroides, and Lachnospira were positively correlated with both antibody levels and spike-specific CD4+ T-cell responses while Methanobrevibacter, Marvinbryantia, Cloacibacillus, and Succinivibrio have a negative one. Within the PLWH group, the gut microbiota taxa associated with CD4+ counts, such as Lachnospira (p=0.002), Oscillibacter (p=0.019) and Flavonifractor (p=0.017), were found to be positively correlated with spike IgG levels. Additionally, the length of ART treatment and CD4/CD8 ratio displayed a positive association with bacterial diversity. Notably, different microbiome profiles and immune status in PLWH, affect their immune responses to vaccination. Conclusion(s): Our results show potential associations between gut microbiota diversity and spike IgG responses after COVID-19 vaccination. These findings were consistent in the whole cohort, albeit group differences between the microbiome compositions in PLWH and HC were observed. Based on our findings, we propose that microbiome modulation could optimize immunogenicity to SARS-Cov-2 vaccines.
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Background: Infancy is an important developmental period when the human microbiome is shaped. Given links between young age at antiretroviral treatment (ART) initiation and smaller persisting viral reservoirs, we hypothesized that earlier ART initiation may leave distinct microbial signatures in the oral cavity detectable in children living with HIV (CLWH). Method(s): Oral swab samples were collected from 477 CLWH and 123 children without HIV at two sites in Johannesburg, South Africa. CLWH had started ART < 2 years of age with 60% starting < 6 months of age. Most were wellcontrolled on ART at a median of 10 years of age when the swab was collected. Controls were age-matched and recruited from the same communities. Sequencing of the V4 amplicon of the 16S rRNA gene was done using established protocols. DADA2, decontam, and phyloseq were used for sequence inference, contaminant removal, and subsequent analyses. All p-values were adjusted for multiple testing using Benjamini-Hochberg false discovery rate method. Statistical analyses were performed with R. Result(s): CLWH had lower alpha diversity than uninfected children (Shannon index p< 0.0001). Genus-level abundances of Granulicatella, Streptococcus and Gemella were greater and Neisseria and Haemophilus were less abundant among CLWH compared to uninfected children. Associations were strongest among boys. There was no evidence of attenuation of associations with earlier ART initiation. In fact, decreased bacterial diversity and differences in taxa abundances in CLWH versus controls were consistent regardless of whether ART was started before or after 6 months of age. Shifts in genus-level taxa abundances relative to uninfected controls were most marked in children on regimens containing lopinavir/ritonavir;with few shifts seen if on regimens containing efavirenz. Conclusion(s): A distinct profile of less diverse oral bacterial taxa was observed in school-age CLWH on ART versus uninfected age-matched children suggesting persisting interference of HIV and its treatments on microbiota in the mouth. Any effects of earlier ART initiation were not detectable at this age. Studies of treated adults with HIV have observed similar shifts in taxa abundances. Oral microbiota have been linked to salivary cytokine levels with associations between Granulicatella and IL-8 and Neisseria and IL-6. Declines in Neisseria abundances in oral samples have been associated with more severe outcomes in influenza and COVID-19.
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Background: Adults living with HIV may have higher risk of SARS-CoV- 2 infection than HIV negative adults. There are no published data on seroprevalence of SARS-CoV-2 in children and adolescents living with HIV (CALWHIV). Method(s): We did a repeat SARS-CoV-2 seroprevalence study in 7 paediatric HIV observational cohorts in 5 countries in the European Pregnancy & Paediatric Infections Cohort Collaboration (EPPICC;Belgium, Greece, Spain, Ukraine, United Kingdom (UK)) and also the Cape Town Adolescent Antiretroviral Cohort (CTAAC), South Africa (SA) (CALWHIV and HIV negative adolescents). Participants gave 2 blood samples for SARS-CoV-2 antibody testing ~6 months apart during routine visits between May 2020 and July 2022, and completed questionnaires on SARS-CoV-2 exposure/infection and vaccine status. Clinical and demographic data were extracted from clinic records. Result(s): Of 906 participants, 53%(477) were female, 89%(803) CALWHIV, median [IQR] age at first visit 17[15-19] years. Most were enrolled in SA (45%, 410/906), UK (23%, 205/906) or Ukraine (18%, 160/906). 85%(767/906) had 2 blood samples and the rest a single sample. For CALWHIV, at time of first sample, 99%(761/765) were on antiretroviral therapy, median CD4 count was 666[478-858] cells/mL, 70%(535/764) had HIV-1 viral load < 50c/mL. Of those with known SARS-CoV-2 vaccine status, 23%(181/773) CALWHIV and 22% (22/100) HIV negative participants received >=1 vaccine dose. 6%(43/762) of CALWHIV had a documented prior SARS-CoV-2 positive PCR (including 2 hospitalised for COVID, neither severe), and 16%(124/762) self-reported previous positive test and/or COVID-19 symptoms, giving a total of 17%(128/762) with any previous infection. Based on serum testing, 63%(562/898) of participants overall were seropositive on at least one sample (55% (269/488) Europe, 67% (205/307) SA CALWHIV, 85% (88/103) SA HIV negative group), and among the unvaccinated subgroup, 53%(408/765) were seropositive (41% (167/412) Europe, 64% (168/263) SA CALWHIV, 81% (73/90) SA HIV negative). Among samples taken prior to or in absence of vaccination, the proportion testing antibody positive increased over time (Figure). Of unvaccinated CALWHIV with >=1 positive result, 17%(52/299) reported any previous SARS-CoV-2 infection. Conclusion(s): Most CALWHIV were SARS-CoV-2 seropositive by mid-2022 despite low vaccine coverage. Fewer had documented or self-reported COVID-19 infection or disease, suggesting most infections were mild or asymptomatic. Seroprevalence of SARS-CoV-2 antibodies in Europe and South Africa, by HIV status and calendar quarter of sampling. Colours indicate dominant variant based on GISAID data for adults and children.
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Background and Importance In 2020 Spain was involved in the SARS-CoV-2 pandemic. This situation entailed in the dispensing of drugs from pharmacy services to patients' homes. This way of reaching the patient facilitated the access to antiretroviral treatment (ART) in this difficult situation. However, due to the social stigmas, certain patients did not consent to access this dispensing system. Aim and Objectives The objective is to study how adherence to antiretroviral treatment was affected in HIV-positive patients during the months of the first alarm state in Spain (March 14 to June 21 2020);because during those period ART was home dispensation. Material and Methods Observational retrospective study, included patients HIV-positive who received ART during the first alarm state in Spain during COVID-19 pandemic and in the same period of 2019. Collected data were: sex, age and variables related to pharmacological treatment (ART in the selected periods, number of dispensations made, galenic units dispensed). To measure adherence, an indirect method was used, comparing the dispensations made in the hospital pharmacy of the hospital of Leon during the studied period and the same dates of the previous year. % adherence = [dispensed galenic units/planned galenic units] x100 Results We analyse 444 patients with a median age of 54 years (45-59) being 77.93% (n=346) men. During the study period 83 patients (18.69%) changed their ART. 38.55% (n=32) carried out a simplification of ART in 2020 (from a treatment based on several pharmaceutical forms to a treatment based on a single one). The mean adherence in the periods studied in 2019 and 2020 was 91.89% (CI 90.44-92.90) and 90.25% (CI 87.61- 92.90), respectively. In 2019, 67.12% (n=298) of patients had adherence greater than 95%, compared to 86.71% (n=385) in 2020. For 38 patients there are no medication dispensations during the 2020 period. Of the majority (n=27) the reason for the absence is unknown;6 were not disposed of from the hospital of Leon for spending the confinement outside the city;4 have died and 1 did not accept home dispensation. Conclusion and Relevance The implementation of home dispensing could have positively influenced adherence in HIVpositive patients. It is necessary to evaluate in the future that the implementation of new telepharmacy programmes can have a positive influence on adherence.
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Introduction: Since its emergence in December 2019, COVID-19 has caused severe morbidity and mortality. Access to healthcare services for individuals with chronic diseases including people living with HIV was disrupted due to many factors such as the density in hospitals and social closure strategies to stop the spread of the pandemic. The aim of this study was to determine whether HIV status and social and medical problems faced by people living with HIV caused anxiety during the COVID-19 pandemic. Material(s) and Method(s): Between October 2021 and February 2022, the Beck anxiety scale and a 16-item questionnaire including questions on demographic information was completed by 100 people living with HIV who visited our Cukurova University Infectious Diseases and Clinical Microbiology outpatient clinic and gave consent to be included in the study. Result(s): Overall, 93 (93%) participants were male and seven (7%) were female, with a mean age of 36 +/- 10 years. Among all participants, 44% reported a decrease in their general quality of life, 42.4% reported an increase in the level of anxiety, 33% reported a decrease in access to resources such as money and food, and 13% reported that they had difficulty in paying the rent of their own house. During the pandemic, 11.3% of the participants lost their jobs and 9.1% lost their health insurance;8.1% reported that they became homeless and moved to live with someone else. Access to antiretroviral treatment decreased in 7.2% of the participants, the number of hospital visits were reduced in 33.3%, and 26% reported a reduction in monitoring tests such as HIV RNA. The mean Beck anxiety score, which was used to evaluate the patients' anxiety level, was 12.32 +/- 12.35 (min-max= 0-54) and suggested mild anxiety symptoms. Conclusion(s): The difficulties and problems in the daily lives of individuals living with HIV have deepened with the COVID-19 pandemic. The data we obtained in our study helps us understand the difficulties and anxiety levels of people living with HIV in receiving healthcare.Copyright © 2022 Bilimsel Tip Yayinevi. All rights reserved.
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Introduction: Since its emergence in December 2019, COVID-19 has caused severe morbidity and mortality. Access to healthcare services for individuals with chronic diseases including people living with HIV was disrupted due to many factors such as the density in hospitals and social closure strategies to stop the spread of the pandemic. The aim of this study was to determine whether HIV status and social and medical problems faced by people living with HIV caused anxiety during the COVID-19 pandemic. Materials and Methods: Between October 2021 and February 2022, the Beck anxiety scale and a 16-item questionnaire including questions on demographic information was completed by 100 people living with HIV who visited our Çukurova University Infectious Diseases and Clinical Microbiology outpatient clinic and gave consent to be included in the study. Results: Overall, 93 (93%) participants were male and seven (7%) were female, with a mean age of 36 ± 10 years. Among all participants, 44% reported a decrease in their general quality of life, 42.4% reported an increase in the level of anxiety, 33% reported a decrease in access to resources such as money and food, and 13% reported that they had difficulty in paying the rent of their own house. During the pandemic, 11.3% of the participants lost their jobs and 9.1% lost their health insurance;8.1% reported that they became homeless and moved to live with someone else. Access to antiretroviral treatment decreased in 7.2% of the participants, the number of hospital visits were reduced in 33.3%, and 26% reported a reduction in monitoring tests such as HIV RNA. The mean Beck anxiety score, which was used to evaluate the patients' anxiety level, was 12.32 ± 12.35 (min-max= 0-54) and suggested mild anxiety symptoms. Conclusion: The difficulties and problems in the daily lives of individuals living with HIV have deepened with the COVID-19 pandemic. The data we obtained in our study helps us understand the difficulties and anxiety levels of people living with HIV in receiving healthcare.
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SESSION TITLE: Cases of Overdose, OTC, and Illegal Drug Critical Cases Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Anchoring bias is a cognitive bias where one relies too heavily on initial information early on in the decision making process, affecting subsequent decisions due to future arguments being discussed in relation to the "anchor. Overemphasis on COVID-19 due to the pandemic has impacted the timely diagnosis and treatment of other diseases. CASE PRESENTATION: A 39-year-old man with a past medical history of COVID 19 in 12/2020 presents to the ED with increasing weakness, chest pain, recurrent fevers, diarrhea, and cough. CXR revealed bilateral infiltrates suggestive of pneumonia/pulmonary edema. Patient was empirically started on ceftriaxone. CT chest was suspicious of COVID-19;however repeat testing was negative. Diarrhea did not improve. Patient later admitted to recent travel to Jamaica. Ova and parasite, C-difficile, and stool culture were negative. On hospital day 8, the patient was intubated and placed on mechanical ventilation for worsening hypoxic respiratory failure Infectious disease was consulted for recurrent fevers of unknown origin and diarrhea with recent travel. Testing for typhoid fever, hantavirus, malaria, HIV, zika virus, chikungunya, dengue, and yellow fever were performed. Consent was obtained for HIV testing. HIV antibody tests were positive, CD4 count of 7, and viral load greater than 900k. Since a new diagnosis of AIDS with a CD4 count of 7 was obtained, the patient was subsequently tested for opportunistic infections such as TB. TB sputum PCR testing was positive but AFB smear was negative for TB. Antiretroviral and tuberculosis treatments were initiated. DISCUSSION: Anchoring bias can delay critical diagnoses and impede patient care if it is not recognized. According to Watson et. al, one way physicians circumvent the thought of pretest probability when ordering tests based on patient history and the subsequent list of differential diagnoses is anchoring bias. Bypassing the pretest probability also alters the sensitivity and specificity of testing because results that do not confirm or rule out a top differential diagnosis are thought to be inaccurate and are then repeated attributing the initial result to a bad specimen or an improper collection of the specimen. CONCLUSIONS: The case presented exemplifies clearly the concept of anchoring bias. Upon initial presentation, the patient had nonspecific symptoms such as weakness, chest pain, recurrent fevers, diarrhea, and cough, all of which can be symptoms of COVID 19 in the setting of a global pandemic. It is clear that the initial diagnosis based on these symptoms was COVID 19. When initial testing was negative, anchoring bias still played a role in the decision to test the patient once again, despite the first negative test. Repeat testing still did not support the diagnosis of COVID 19, which expanded the differential diagnosis and ultimately led to the correct diagnosis of AIDS with concomitant TB infection. Reference #1: Saposnik, et. Al. Cognitive Biases Associated with Medical Decisions: A Systematic Review. BMC Med Inform Decis Mak. 2016 Nov. 3. PMID: 27809908 Reference #2: Harada, et. al. COVID Blindness: Delayed Diagnosis of Aseptic Meningitis in the COVID-19 Era. Eur J Case Rep Intern Med. 2020 Oct 23. PMID: 33194872. Reference #3: Singh, et. al. The Global Burden of Diagnostic Errors in Primary Care. BMJ Qual Saf. 2016 Aug 16. PMID: 27530239. DISCLOSURES: No relevant relationships by Sagar Bhula
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Introduction/ Background: Nigeria, like the rest of the world, introduced public health measures to control SARS-CoV-2 infection. These measures especially movement restrictions impacted all aspects of citizens' life including health services. This study was conducted to determine the impact of COVID-19 movement restriction on treatment outcomes among individuals living with HIV/AIDS. Methods: This was a retrospective review of the electronic database at the HIV clinic of the Nigerian Institute of Medical Research over a 5-month period (three months before, during, and after the COVID-19 movement restriction). The study population were people living with HIV attending the HIV clinic. Information on sociodemographic, and clinical (type of ARTs, duration on ART, laboratory evaluation) were extracted from database and analyzed using the SPSS version 22.0. Results: The data of 4145 individuals in the database were extracted and reviewed. The median age of PLWH was 45 years, with the majority within the age group being 25-49years (65.4%), married (59.5%), had at least secondary education (82.8%), and employed (81.5%). The median duration on ARTs was 102 months (IQR: 67-138) with the most on non-Protease Inhibitor based regimen (77.7%). The drug pickup declined by 40% from the pre-movement restriction period levels. Three months post movements restriction, laboratory monitoring for treatment outcomes were mostly affected as none of the patients had their routine test performed during the locked down period. Impact: The COVID -19 movement restriction had a significant impact on the treatment access among people living with HIV. This could portend untowards public health effect on the gains of HIV care. Conclusion: The COVID -19 movement restriction resulted in the decline of antiretroviral drug pick by 40% and almost no performance of laboratory monitoring HIV diseases. It is recommended that in future restriction of movement government and institutions should put in palace contingency plan to ensure that HIV services are not compromised.
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BACKGROUND: The COVID-19 pandemic triggered high mortality in the world population and resulted in impacts on health services. Services related to HIV care and prevention were discontinued and concerns about the impacts of COVID-19 on people living with HIV (PLHIV) were discussed in different countries. In this setting, the COVID-19 pandemic has provided a decrease in combination HIV prevention, which involves access and use of HIV services, including decreasing HIV pre-exposure prophylaxis (PrEP) prescriptions, post exposure prophylaxis (PeP), interruptions in HIV ongoing care of people living with HIV and access to HIV testing. The aim of this study is to assess the implications of the COVID-19 pandemic for combination HIV prevention. METHODS: A systematic review of observational studies was performed according to the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA). Searches were conducted in PubMed, Embase, CENTRAL, Lilacs and OpenGrey, which included studies on the impacts of the COVID-19 pandemic on prevention and care services for patients living with HIV, namely: PreP, PeP, antiretroviral treatment and testing, published until October 2021. The main impacts on these services were analyzed according to the average income of the countries. Data from the included studies were independently extracted by four reviewers. For the final articles that were selected, the following data was extracted: year of publication, study design, study site, sample size, mean age of participants, type of PrEP, adaptations to services during the pandemic and country income. RESULTS: The search identified 1396 studies, of which 90 were eligible. Most studies were cross-sectional (n=30, 32.97%) and qualitative (n=33, 36.26%), mostly performed in high-income countries. USA had the largest number of studies (n=35, 38.46%). The main themes of the selected studies were related to the repercussion of the pandemic on the health of people living with HIV (n=21, 23.08 %), in the combined prevention of HIV (n=18, 19.78%), testing and use of PrEP (n=11, 12.09% -each) and adaptations in services were also reported to maintain the provision of care (n=11, 12.09%). The most used strategy for offering the service was telehealth for consultations related to the treatment and monitoring of PrEP users. The results suggest regional discrepancies and according to the average income of the countries. Low-and middle-income countries were more affected and populations were more exposed to discontinuity in treatment and access to combination HIV prevention. It was observed that qualitative studies predominantly assessed changes in HIV prevention and treatment services. CONCLUSIONS: The Covid-19 pandemic had an impact on reducing the supply of combination HIV prevention. Systems of healthcare need to adopt adaptations in the health services in order to establish effective strategies to increase testing and access to telehealth for the population living with HIV, specially in low income countries.
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Background: Arterial hypertension has been described as one of the main risk factors for poor prognosis in Covid-19. In this context, the role of angiotensin-converting enzyme 2 (ACE2) in this infection has been studied, with studies showing how this enzyme acts as a functional receptor for SARS-CoV-2, favoring the penetration of the virus into the cell. The main objective of this work is to study the impact of chronic antihypertensive treatment in a cohort of SARS-CoV-2 positive patients with arterial hypertension, as well as clinical outcomes during hospitalization. Method: Single-center observational retrospective cohort study conducted at a tertiary level university hospital from 1st March 2020 to 31st May 2020. All adult patients admitted with a diagnosis of COVID-19 and a history of arterial hypertension on chronic treatment with an antihypertensive drug during the three months prior to contracting the infection were included. For the analysis, patients were divided into three groups according to the chronic antihypertensive treatment they were receiving: angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin II receptor antagonists (ARB) or other treatment, excluding those patients who during the three months prior to the start of the study had been on concomitant treatment with ACE inhibitors and ARB, as well as those on treatment with more than four antihypertensive drugs. Results: A total of 475 cases with positive PCR for SARS-CoV-2 cases had hypertension as an associated comorbidity on antihypertensive treatment in the three months prior to admission. The mean age of this cohort of patients was 77.05 (SD 10.95) years, most of them male (56.8%) Regarding the prolonged length of stay variable, 127 patients (26.7%) were admitted for 14 days or more, with no statistically significant differences between the three groups. For patients admitted to the Intensive Care Unit (ICU) (29 patients, 6.1%) no differences were observed between the three study groups either.Regarding the outcome variable, all-cause in-hospital mortality, no statistically significant differences were observed between the groups (p = 0.836). Conclusions: Patients admitted with SARS-CoV2 respiratory infection with a diagnosis of hypertension and pre-admission treatment with an antihypertensive drug showed no statistically significant differences in mortality between those hypertensive patients who received renin-angiotensin-aldosterone system (RAAS) inhibitor antihypertensive drugs and those who received other antihypertensive treatments.
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Background: The immunogenicity and safety of mRNA-based vaccination in people living with HIV have yet to be clarified. We aimed to describe the impact of SARS-CoV-2 mRNA vaccination on safety, HIV-RNA control, and humoral immune responses after two doses of vaccine. Methods: From January 2021 to April 2021, vaccination with mRNA1273 (Moderna) and BNT162b2 (BioNTech/Pfizer) was offered to every individual with HIV registered at our institution who fulfilled vaccination criteria and consented to routine vaccination. HIV-1 RNA levels and anti-SARS-CoV-2 S total Ig (Elecsys®, Roche Diagnostics, Rotkreuz, Switzerland) were measured at the time of the first and second doses, 30 days later, and at 6 months after the first dose. Results: The study sample included 131 individuals (median age: 54 years [interquartile range (IQR): 47-60.5]);male: 70.2%;median baseline CD4-T cell: 602 cells/μ l [IQR: 445.0-825.5]). HIV viral load data were collected for 129 patients at the time of the first dose (M0) and 30 days later (M1);for 124 patients, 30 days after the second dose (M2);and for 42 patients, 6 months after the first dose (M6). Twenty (15.5%) of 129 patients had detectable HIV-1 RNA (>20 copies/ml;IQR: 24.0-43.5) at M0, 13/129 (10.1%) at M1 (among which 5 were newly detected), 15/124 (12.1%) at M2 (among which 4 were newly detected), and 6/42 (14.3%) at M6. HIV-RNA levels returned below the detection threshold of 20 copies/mL at the subsequent measure. All analyzed patients showed a positive anti-SARS-CoV-2 S Ig after vaccination with geometric mean titers (GMT) of 131.8 U/ml (95% CI: 130.4-133.2) 30 days after the first dose and 2003.4 U/ml (95% CI: 2002.3-2004.4) 30 days after the second dose. Six months after the first dose, 75/131 patients were analyzed, and they were all still positive for anti-SARS-CoV-2 S Ig, with GMT of 1132.2 U/ml (95% CI: 1131.0-1133.4). We found no statistical significance in anti-SARS-CoV-2 S Ig titers between patients with detectable and undetectable HIV-1 RNA. No serious adverse effects were reported. Conclusion: In a patient population on effective antiretroviral drugs, only minor or transient effects of mRNA vaccines on HIV-1 RNA levels were observed. All patients developed anti-SARS-CoV-2 S total antibodies after two-dose vaccination and antibodies were detectable in all analyzed patients 6 months after the first dose.
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Background: Routine medical care was drastically affected by the overwhelming irruption of COVID-19 pandemic. We comprehensively assessed the impact of the COVID-19 pandemic on the prevention and care for HIV and other sexually transmitted infections at a large reference hospital providing preventive and clinical services for HIV infection and other sexually transmitted infections. Methods: We retrospectively compared clinical and laboratory data from March to December 2020 (first ten months of the SARS-CoV-2 epidemics in Spain) vs. the same period 2019 in the setting of Hospital Clínic of Barcelona which provides preventive and clinical services for HIV infection and other sexually transmitted infections for the region of Catalonia and is the largest of its kind in Spain. Monthly clinical data on HIV pre-exposure and post-exposure prophylaxis users and on adults with HIV infection were retrieved from the administrative hospital database. Monthly tests for HIV, hepatitis B and C, Treponema pallidum, Neisseria gonorrhoeae, and Chlamydia trachomatis, and plasma lipids and glucose were recovered from the laboratory database. De novo HIV, hepatitis B, or hepatitis C diagnosis were considered whenever a person had a first known positive laboratory test. Results: There were less (28% reduction) but more advanced (mean [SD] CD4 cell counts per mm3 at HIV diagnosis 305 [167] vs. 370 [170], P<0.001;26 (18%) persons had AIDS-defining conditions at HIV diagnosis vs. 20 (10%), P=0.03) HIV cases and more gonorrhea (39% increase, P<0.001) and chlamydia (37% increase, P<0.001) infections in 2020 vs. 2019. In people with HIV, rates of viral load above the level of detection remained stable (11% vs 11%, P=0.147) despite less scheduled visits (25% reduction, P<0.001). However, they had less antiretroviral prescription changes (10% reduction, P=0.018), worse plasma lipids (mean total cholesterol 190 vs 185 mg/dL, P<0.001;mean LDL cholesterol 114 vs 110 mg/dL, P<0.001;mean triglycerides 136 vs 125 mg/dL, P<0.001;mean HDL cholesterol 47 vs 48 mg/dL, P=0.006), and an excess of mortality (29 deaths vs 11, 264% increase, P=0.006) due in great part to COVID-19 (n=11) but also to other non-COVID-19 causes. Conclusion: In the setting of a large Spanish reference hospital, SARS-CoV-2 epidemics was associated with an increase of some prevalent sexually transmitted infections, with less but more advanced de novo HIV infections, and with worse non-virologic healthcare outcomes and higher mortality in people living with HIV.
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The HIV epidemic in Latin America remains concentrated in large urban centers, with vulnerable populations suffering the highest burden, particularly MSM and transgender women. In the last 10 years, the number of new HIV infections remained high and stable, and although ART coverage led to a significant decrease in AIDS-related mortality, the decrease was lower in Latin America when compared to the other regions. Brazil accounts for more than one-third of the HIV burden of the region. It was the first low-/middle-income country to provide access to universal treatment to individuals living with HIV. Brazil's actions towards the AIDS crisis assumed a human rights-based approach, integrating both prevention and treatment efforts into its universal health care system. Brazil's civil society organizations play a crucial role in shaping the initial and ongoing response. Since 2014, a "Treat All" policy of providing antiretroviral treatment in addition to comprehensive services including HIV testing and laboratory monitoring, and pre-exposure prophylaxis has been in place. The impact of the policies on people living with HIV resulted in an improved quality of life and a decline in overall morbidity and mortality. Nonetheless, important challenges remain, including a high and stable HIV incidence among key populations, and a high prevalence of late treatment initiation and of early mortality from AIDS causes, impacting the multiple steps of the continuum of care. This presentation will (a) present recent epidemiologic data on the HIV epidemic in Latin America, (b) describe and detail the characteristics of the Brazilian response to the HIV epidemic and the current status of the epidemic in Brazil, and (c) share Brazil's contribution to cutting edge AIDS research and its impact on public health policies. The latter will focus on how the data emanating from research efforts have contributed to major innovations for the HIV prevention and care agenda. Areas highlighted include pMTCT, tuberculosis, ART strategies for treatment and prevention including pre-exposure prophylaxis, and vulnerable populations, particularly young MSM and transgender women, HPV, reproductive health, and COVID-19. These research advances were only made possible through close engagement with the community. It is through this strong community engagement that we aim to reduce stigma and discrimination while promoting human rights.
ABSTRACT
Background: The COVID-19 pandemic has had significant impacts on the healthcare system, including HIV outpatient care. Lockdowns, infection concerns, and staffing and resource shortages had the potential to affect patient care and viral suppression. Methods: We conducted a retrospective analysis of patients at six HIV primary care clinics in New York City in the Mount Sinai Health system. We compared outcomes in a pre-COVID period [PC], Mar 2019-Feb 2020, to a COVID period [CP] of Mar 2020-Feb 2021. Demographics of interest included age, sex, race/ethnicity, and HIV risk factor. In the two time periods we compared viral load suppression (VLS;HIV RNA <200 copies/mL), primary care encounters, antiretroviral (ART) prescribing, and hospitalizations. We then evaluated predictors of loss of VLS or loss to follow-up in a logistic regression model. Results: Our cohort was comprised of 9,740 HIV primary care patients with ≥1 viral load measurement PC. Median age was 53 years and 79% were male;20% were white, 37% Black, and 30% Hispanic. 42% had an HIV risk factor of MSM, 22% heterosexual sex, and 4% injection drug use (IDU). 87.9% (8559/9740) of the PWH during PC had VLS. While 90.7% (7268/8013) of the population assessed during CP had VLS, 18% of the initial cohort had no VL testing during this period and 15% had neither testing nor a clinical visit during CP. In CP, 13% had at least one measured detectable HIV VL (≥200 copies/mL). Primary care encounters decreased from 93% to 79%. ART prescription rates were unchanged: 88% had active prescriptions for >80% of the year both PC and in CP. All-cause hospitalizations decreased from 766 (7.9%) to 633 (6.5%;p<.001). Male sex (OR 1.32,CI 1.17-1.49), identification as a transgender woman (OR 1.81,CI 1.22-2.69), age <35 years (OR 1.74,CI 1.53-1.97), Black race (OR 1.4,CI 1.23-1.59), and HIV risk factor of heterosexual sex (OR 1.54,CI 1.34-1.77) and IDU (OR 1.73,CI 1.35-2.22) were associated with loss of VLS or loss to follow-up. Conclusion: In this large cohort of PWH in a NYC medical system, viral suppression of those who remained in care remained stable-yet a substantial portion of patients were not engaged in care and monitored for VLS during the CP. Strategies to retain patients in care and ensure suppression (eg, with televisits and care coordination) may have helped mitigate effects of the pandemic. Clinics must continue targeted efforts to re-engage patients, facilitate access to testing, and prevent longstanding loss to follow-up in at-risk groups.
ABSTRACT
Background: The coronavirus disease (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is characterised by a wide spectrum of clinical phenotypes ranging in acuteness from asymptomatic, symptomatic with mild or moderate manifestation and severe involving pneumonia and respiratory distress. COVID-19 susceptibility, severity and recovery have demonstrated high variability worldwide. Variances in the host genetic architecture may potentially control the inter-individual and population scale differences in COVID-19 presentation. Methods: We performed a genome-wide association study (GWAS) employing the genotyping data from Ancestry DNA COVID-19 host genetic study that included COVID-19 positive patients and healthy individuals who had tested negative for SARS-CoV-2 infection at the time of recruitment. We restricted our analysis only to the individuals of European descents to avoid genetic structure in the dataset, arising due to the presence of people from different ancestries. Further, we uniquely employed the asymptomatic individuals as controls instead of healthy individuals. Results and Discussion: Our data revealed striking genomic differences between COVID-19 asymptomatic and severely symptomatic individuals. We identified 621 genetic variants that were significantly distinct (Multiple-testing corrected P<0.001) between asymptomatic and acutely symptomatic COVID-19 patients. These variants were found to be associated with pathways governing host immunity, such as innate and adaptive immune system, interferon signaling, interleukin signaling, antigen processing by MHC, cytokine signaling and known COVID-19 comorbidities, such as obesity, cholesterol metabolism and smoking. Variants modulating drug responses including to anti-retroviral agents were also found to vary significantly between asymptomatic and severe patient groups.
ABSTRACT
Background. HIV is a significant risk factor for acquiring SARS-CoV-2 infection and is associated with increased risk of mortality from COVID-19. Information on the clinical characteristics of persons living with HIV(PLWH) hospitalized due to COVID-19 infection are inconsistent and sparse. As Miami area is currently the epicenter of new HIV infection, an understanding of the clinical characteristics of COVID-19 in hospitalized HIV patients in South Florida is needful. Methods. This is a single center retrospective case series analysis of individuals with HIV hospitalized with COVID-19 from March 1, 2020 to March 31, 2021. We analyzed relevant data related to demographics, comorbidities, clinical presentation, HIV viral load and CD4 profiles, serum inflammatory markers, COVID-19 treatment and survival. Results. 25 patients were identified. The demographic, socioeconomic and clinical data are described in Table 1. 88% of subjects. were on HIV antiretroviral treatment (ART) but only 60% had CD4 counts > 200cells/mm3. More study results are shown in Figures 1 and 2. The serum ferritin ranged from 29 to 40,577ng/ mL while serum creatinine ranged from 0.51 to 2.8mg/dL, mean 1.04± 0.46 mg/ dL. The Pearson correlation between serum ferritin and serum creatinine (SCreat) was 0.715, p < 0.001 and between lymphopenia and SCreat, it was 0.544, p=0.005. 40% of subjects with CD4 < 200 cells/mm3 died compared to 33% with CD4 > 200 cells/mm3. Conclusion. This first case series of hospitalized COVID-19 patients in PLWH illustrate important demographic and socioeconomic trends with an imbalance towards African Americans. The group mortality rate appear to be higher compared to the overall mortality rate of COVID-19 reported in the general population or other published HIV-COVID-19 coinfection case series. This is not surprising given the fact that only 64% of the cohort had undetected viral load and only 60% had CD4 counts > 200 despite reported 88% ART use. Correlations between lymphopenia and serum ferritin on one hand and serum creatinine on the other hand should be further explored in a larger case series or prospective study. Since COVID-19 mortality is related to HIV severity, improving socioeconomic status and ART compliance could play a big role in positively improving outcome of hospitalized HIV-COVID 19 patients.
ABSTRACT
Background. HIV outpatient in-person (IN-P) visits were limited during the COVID-19 pandemic, and most patients (pts) were cared for remotely through telehealth (TELE). We sought to evaluate the impact of TELE on HIV infected pts during the pandemic compared to the pre-pandemic IN-P care. Methods. Retrospective chart review of pts in an outpatient HIV clinic, study period 03/30/2019 to 03/29/2021. Two periods were defined: pre-COVID (Pre-CO) 3/30/2019 to 3/29/2020 and COVID (CO) 3/30/2020 to 3/29/2021. Data was collected on demographics, HIV risk, type of encounter, number of encounters, CD4, HIV Viral loads (VL) at first, and last visit, treatment regimen information. HIV VL < 200 copies/ ml was considered as undetectable. Results. A total of 607 pts were evaluated. Mean age 51years;(Range-20-84). Male 306 (50.4%), African American 545(90%), Hispanic 50 (8.2%), white 9 (1.5%), Asian 3(0.5%). HIV risk: heterosexual 437(72%), male sex with male 118(19.4%), intravenous drug use 8 (1.3%). In the Pre-CO period, 530 pts were seen as IN-P;in the CO period 606 pts were encountered of which 304 (50.2%) were TELE visits, 89(14.7%) IN-P, 213(35%) had both TELE and IN-P encounters. Mean number of encounters were 2.59 in the Pre-CO and 2.46 during CO. The number of new pts in the Pre-CO were 36 (7%) vs. 52(8.6%) in the CO (p=0.26). During the pre-CO, 373 pts had CD4 measured at first and last visits, 353(95%) at the first visit and 352 (94.3%) at the last visit had CD4 counts ≥ 200/uL (p=.87);373 pts had a VL done at first and last visits, 330 (88.5%) at the first visit and 337(90.3%) at last visit were undetectable (p=0.41). During CO, 445 pts had CD4 measured at first and last visits, 402 (90.3%) at the first visit and 445(94.2%) at the last visit had CD4 count ≥200/uL (p=0.03);448 pts had VL measured at first and last encounters, 389(87%) at the first visit and 417(93%) in the last visit were undetectable (p=0.002). Antiretroviral changes occurred in 29% in the Pre-Co compared to 19% in the CO (p=0 .32). Conclusion. In our clinic, more pts were cared for during the CO period compared to the Pre-CO period. Significantly, more pts had undetectable HIV VL during CO period. At least one TELE visit was utilized by over . of the pts. TELE has a potentially important role in future HIV care without compromising patient outcomes.