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Evaluating virological outcomes in people with HIV on stable ART with reduced frequency of HIV viral load monitoring during the COVID-19 pandemic
Less Viral Load Tracking During COVID Has No Immediate Ill Effects
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18th European AIDS Conference, EACS 2021, October 27-30, 2021, London
Mark Mascolini
Reduced viral load monitoring resulting from restricted HIV outpatient visits during the COVID pandemic in the United Kingdom (UK) caused little short-term harm in an analysis of 2677 people with a stable pre-COVID HIV load at a single center in London [1]. But a concerning proportion of the study group had not returned for a viral load test after 14 months.
Across the world the COVID-19 pandemic disrupted care of countless people with chronic disease who require regular monitoring. In the UK HIV-positive people with stable viral suppression through antiretroviral therapy (ART) get a viral load check every 6 months. But the arrival of COVID early in 2020 placed restrictions on outpatient visits by people with HIV and thus resulted in growing gaps between viral load tests.
Researchers at Imperial College London and University College London conducted this study to explore the impact of reduced viral load monitoring on virologic outcomes during the pandemic and to compare outcomes with those in the year before COVID spread across the UK.
The investigators identified people taking a stable antiretroviral regimen with a viral load below 200 copies between March 2018 and February 2019. They compared outcomes between the pre-COVID period (March 2019 through February 2020) and the COVID period (March 2020 through February 2021). Outcomes of interest were frequency of viral load testing, longest duration between tests, and virologic consequences in people whose viral load rose above 200 copies.
The 2677 people studied had a viral load below 200 copies during at least 6 months of steady antiretroviral therapy. They had a median age of 51, 50% were white, 27% black, and 16% Asian, mixed, or other. While 60% of the group listed sex between men as their route of HIV acquisition, 32% cited heterosexual sex. Most recent median CD4 count measured 697 (interquartile range [IQR] 535 to 887), while median nadir CD4 count lay at 240 (IQR 110 to 390).
Among these 2677 people, 2571 (96%) had a viral load below 200 copies during the pre-COVID year. During the COVID year 523 of these 2571 people (20.3%) did not have a viral load test, 45 (1.8%) had a viral load result above 200 copies, and 2003 (77.9%) had a viral load measured below 200. Among the 45 people with a viral load above 200 copies during COVID, only 2 (4.4%) had resistant virus emerge.
Among the 523 people who did not have a viral load test during the COVID year, the researchers had follow-up results for 410. Most of these people, 332 (81%), had not returned for a viral load test, 2 dropped out of care entirely, and 76 had a subsequently measured viral load below 200 copies. Thus of 410 people who had no viral load test during COVID and had results available for this analysis, 332 (81%) had yet to reappear for viral load testing.
Comparing the pre-COVID year with the COVID year, the researchers found that the average number of viral load tests per patient fell by half from 2.3 to 1.1. The average longest span between viral load tests jumped from 29.5 weeks to 43.7 weeks. And the number of previously virologically stable people who did not have a viral load test soared from 82 (3% of the group) in the pre-COVID year to 581 (28% of the group) in the COVID year.
The most concerning insight from this analysis does not involve the 2 people who had resistant virus emerge during the COVID-related gap in viral load monitoring. Rather, the high proportion of people who have yet to get their viral load measured since COVID appeared underlines the need to urge HIV patients back to face-to-face care and regular monitoring now that vaccination and masking greatly limit chances of SARS-CoV-2 transmission in the HIV clinic.
Reference
1. Alagaratnam J, Sabin C, Garvey LJ, Ramzan F, Winston A, Fidler S, Mackie NE. Evaluating virological outcomes in people with HIV on stable ART with reduced frequency of HIV viral load monitoring during the COVID-19 pandemic. 18th European AIDS Conference, EACS 2021, October 27-30, 2021, London. Abstract BPD3/3.
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