Impact of the COVID-19 Pandemic on the Medical Follow-up and Psychosocial Well-Being of People Living With HIV

A Cross-Sectional Survey

Joseph Nelson Siewe Fodjo, MD; Edlaine Faria de Moura Villela, MD, PhD; Stijn Van Hees, PharmD; Thalia Tibério dos Santos; Pieter Vanholder, MA; Patrick Reyntiens; Rafael Van den Bergh, PhD; Robert Colebunders, MD, PhD

Disclosures

J Acquir Immune Defic Syndr. 2020;85(3):257-262. 

In This Article

Abstract and Introduction

Abstract

Background: Empirical data on the consequences of the novel coronavirus disease (COVID-19) pandemic on HIV care are lacking. We surveyed people living with HIV (PLWH) in different countries to investigate whether their medical follow-up and psychosocial well-being had been compromised due to COVID-19 and associated restrictions.

Methods: In April 2020, a cross-sectional survey among PLWH was conducted using a web-based multilingual questionnaire. The research tool assessed HIV follow-up, psychosocial well-being, COVID-19 (flu-like) symptoms and prevention measures. Consenting respondents provided answers anonymously.

Results: Three hundred seventeen PLWH were included (mean age 43.4 ± 11.7; 71.6% men); 60.3% of participants resided in Belgium and Brazil. One hundred forty (44.2%) reported experiencing a cold with at least one flu-like symptom since January 2020. Of the 18 who reported COVID-19 test results, 4 (22.2%) were positive. Seventy-four (23.3%) respondents screened positive for major depressive disorders, whereas 72 (22.7%) had generalized anxiety disorders. Fifty-six (17.7%) respondents reported difficulties in obtaining antiretroviral medications because of COVID-19–related measures. Adaptations of HIV care during the COVID-19 outbreak included greater quantities of antiretroviral refill in 67 (21.1%), phone consultations in 25 (7.9%), and new refill sites in 12 (3.9%). Factors associated with a reduced risk of experiencing flu-like symptoms included flu vaccination during the past 12 months (P = 0.005) and adaptations of HIV care during the COVID-19 pandemic (P = 0.010).

Conclusion: COVID-19 and associated restrictive measures seem detrimental to the well-being and follow-up of PLWH. We recommend that health systems devise innovative approaches for antiretroviral provision and psychosocial support to PLWH during such outbreaks.

Introduction

The severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2) outbreak that began in China in December 2019 has attained global proportions. Health systems around the world are severely affected by the coronavirus 2019 disease (COVID-19) pandemic, as the disease directly impacts the general population and specific vulnerable populations while also indirectly affecting non–COVID-19 health care. People living with HIV/AIDS (PLWH) represent a specific, vulnerable population that may potentially be confronted with manifold COVID-19–related risks.[1] First, their reduced immune competence and higher prevalence of comorbidities could create a favorable terrain for severe disease. Second, COVID-19 disease may be more subtle to diagnose in PLWH because its symptoms resemble those of some pulmonary complications of HIV. Third, large numbers of severely ill COVID-19 infected persons could overwhelm the health care system and compromise the quality and continuity of HIV treatment and care.[2]

PLWH accounted for 0.8%–1.4% of hospitalized COVID-19 patients in studies from Wuhan (China), the United Kingdom, Barcelona (Spain), and New York (United States).[3–6] Initial data from small case series suggested that COVID-19 mortality in PLWH was rather low, and often attributable to comorbidities rather than HIV itself.[7,8] However, recent preliminary findings from South Africa reveal that PLWH are at a higher risk of dying from COVID-19 compared with HIV-negative persons [hazard ratio: 2.75, 95% confidence interval (CI): 2.09 to 3.61].[9] Of note, COVID-19 mortality among PLWH in the latter study did not depend on viral suppression or the stage of HIV infection but was almost exclusive to those who had comorbidities (mainly diabetes and hypertension).[9]

It has been suggested that PLWH are not very likely to develop a severe form of COVID-19 infection because some antiretroviral treatment (ART) regimens may have some activity against the coronavirus.[10] In this regard, ritonavir was investigated but did not prove effective against the SARS-Cov-2 in clinical studies.[11] Another antiretroviral drug suspected to have an anti–COVID-19 effect is tenofovir, given its structural similarity with remdesivir. Both drugs can tightly bind the RNA-dependent RNA polymerase (RdRp) of the SARS-Cov-2. Moreover, a recent trial with remdesivir showed that the drug significantly reduced recovery time and improved survival in hospitalized COVID-19 patients.[12] Therefore, tenofovir may also be active against the SARS-Cov-2 and could represent a promising tool in the fight against COVID-19.[13] Studies are underway to confirm its efficacy against the SARS-Cov-2.[14]

So far, little is known on the impact of COVID-19 on the medical follow-up and well-being of PLWH as the pandemic evolves. Besides causing a multiorgan disease, COVID-19 also poses a threat to the emotional and social well-being of PLWH and could interfere with routine HIV care by overburdening health facilities.[1] Anxiety and depressive disorders have previously been reported in PLWH,[15–17] and it is expected that the COVID-19 outbreak would exacerbate these symptoms because of widespread fear that is partly fueled by COVID-19 misinformation through the social media.[18] Also, little is currently known regarding the continuity of HIV care during the COVID-19 outbreak with the associated restrictions, particularly in resource-limited settings with underperforming health care systems. Confinement may lead to poor ART adherence as a result of disruptions in the supply chain and concerns about increased exposure to coronavirus in hospital settings, thereby discouraging PLWH from showing up for follow-up visits.[19] Recently, the South African National Laboratory Service reported a 10% drop in viral load testing in the public sector, suggesting indeed an interruption of HIV care.[9] In view of all these knowledge gaps, we conducted a survey to assess the possible consequences of the COVID-19 pandemic on the health and psychosocial well-being of PLWH, their access to health care services, and ART provision.

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