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Indirect HIV morbidity and mortality due to COVID-19- PLWH presenting with more advanced HIV
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Clinical Infectious Diseases
13 February 2021
we would like to offer a different perspective on the repercussions of the pandemic on PLWH, which goes beyond the direct effects of COVID-19 illness.
At the end of the first European COVID-19 wave, we noticed an increased number of PLWH being admitted with advanced HIV disease/AIDS. We examined HIV inpatient admissions at Chelsea and Westminster Hospital, London, UK (a tertiary referral centre for HIV/oncology), between July and October 2020, and compared them to those within the same period in 2019 (Table 1).
Although there was a reduced absolute number of hospitalisations in the 2020 period, we observed a significantly higher proportions of admissions due to AIDS defining conditions (p=0.023). Whilst in 2019 26.5% of admissions were due to an AIDS defining illness (48% with an oncological diagnosis, 52% with an opportunistic infection, OI), in the 2020 period, over half of admissions were due to AIDS defining conditions (54%), with OIs and oncological diagnoses accounting for 72% and 28% of cases, respectively.
Moreover, among hospitalised patients in the 2020 period, we observed a higher proportion of new HIV diagnoses (16% vs 6%, p=0.073), lower CD4+ counts (median CD4+ 157 in 2019 versus 63 in 2020, p=0.0076) and higher HIV viral loads.
...These findings suggest that patients presented to hospital with more advanced HIV disease in the second half of 2020, compared to the same time period in 2019. We believe this variation could be due to difficulty in accessing healthcare and/or reluctance to attend healthcare facilities during the first wave of the COVID-19 pandemic and the inevitable lock-down, as observed in the HIV negative population [5-7]. Hence, when addressing the consequences of this pandemic on PLWH, it is important to consider the additional repercussions in accessing HIV testing and HIV diagnosis, and people linkage to care, ultimately translating into increased morbidity for PLWH.
Hence, when addressing the consequences of this pandemic on PLWH, it is important to consider the additional repercussions in accessing HIV testing and HIV diagnosis, and people linkage to care, ultimately translating into increased morbidity for PLWH.
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