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


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

In This Article


Participant Characteristics

Data from 317 respondents were eligible for analysis. The mean age was 43.4 ± 11.7 years (range: 19–75); men were more represented in our study population (Table 1). Responses originated from 32 countries, half of which were classified as LMIC. Of note, most participants resided either in Belgium (n = 102, 32.2%) or Brazil (n = 89, 28.1%); 59 (18.6%) responses originated from Eastern European countries (Supplementary appendix 1). Anxiety and depressive disorders were found in 72 (22.7%) and 74 (23.3%) participants, respectively, (Table 1); 50 PLWH (15.8%) had both anxiety and depressive disorders.

Regarding HIV treatment, the most frequently used antiretroviral molecules among our participants were tenofovir in 193 (60.8%), lamivudine in 144 (45.4%), and dolutegravir in 131 (41.3%). Thirteen (4.2%) participants reported an interruption of ART during the COVID-19 lockdown period. Difficulties related to ART refill during the COVID-19 pandemic included ART stock out at the clinic/pharmacy in 6 (1.9%); inability to go collect ART due to mobility restrictions in 21 (6.6%); and financial constraints in 2 (0.6%) participants. One hundred four (32.8%) participants reported some form of adaptation of HIV care during the COVID-19 lockdown period; adaptation strategies ranged from changing the amounts of ART refills to teleconsultation for HIV follow-up (Table 2).

One hundred thirty-eight (44.2%) respondents reported being less likely to interrupt ART during the lockdown period; meanwhile, 11 (3.5%) were more likely to interrupt their treatment, and another 163 (52.2%) were as likely to stop ART as before the COVID-19 lockdown. More than half of the respondents (200 PLWH [63.1%]) reported recreational substance use, including consumption of alcohol, tobacco, and marijuana (see Appendix 4, Supplemental Digital Content,

COVID-19–Reported Symptoms and Preventive Behaviors in PLWH

Among the 140 (44.2%) PLWH who had experienced a cold since January 2020, the most frequent self-reported symptom was coryza (65.7%). Similar symptoms were reported by PLWH with a history of flu vaccination during the past 12 months and those who were not vaccinated (Table 3). Of note, all 4 PLWH who reported positive COVID-19 test results had at least one flu-like symptom. Applying the WHO clinical definition for COVID-19[23] on our entire study population (while assuming no previous contact with an infected individual), it was revealed that 54 (17.0%) of respondents were classified as suspected COVID-19 cases.

Regarding coronavirus-related behaviors, most of the participants reported adhering to the protective measures to reduce their risk of contracting or spreading COVID-19; 285 (89.9%) observed the 1–2 m physical distancing, 209 (65.9%) used face masks, 277 (87.4%) regularly washed their hands with water and soap during the day, 190 (89.9%) covered their mouth when coughing, and 200 (63.1%) avoided as much as possible to touch their face (eyes, nose, and mouth). Observance of COVID-19 preventive measures was not different among PLWH who reported anxiety/depressive disorders and those who did not. A few disparities were noted between the characteristics and preventive behaviors of respondents who resided in LMIC compared with those in high-income settings (Table 4).

We also compared our findings based on the continent of residence of the respondents as follows: Europe (n = 202), Latin America (n = 90), and Asia (n = 23); the 2 PLWH who resided in Africa were excluded from this analysis. We observed that PLWH in Asia were younger and had the lowest flu vaccination rates, whereas physical distancing was most frequently observed by PLWH in Europe (see Appendix 2, Supplemental Digital Content, In addition, no significant differences were noted in the prevalence of anxiety (P = 0.833) and depression (P = 0.650) across the continents. Further comparisons within the European continent revealed that PLWH from Eastern European countries (n = 59) were less often vaccinated against flu and used face masks more frequently compared with those residing in Western Europe (n = 143) (see Appendix 3, Supplemental Digital Content, Similar proportions of PLWH in Eastern and Western Europe had depressive disorders (P = 0.171); however, anxiety tended to be more frequent among Eastern Europe residents, albeit nonsignificantly (30.5% vs 17.5% in Western Europe; P = 0.062) (see Appendix 3, Supplemental Digital Content,

Factors Associated With the Development of Flu-like Illness During the COVID-19 Outbreak

A multiple logistic regression model was constructed to investigate relevant factors that may be associated with the development of flu-like symptoms among PLWH. We did not include the participants' CD4 count in the final model because that information was not available for many participants (76 missing values), and moreover, no association was observed between CD4 count and the development of flu-like symptoms when conducting bivariate analysis (odds ratio = 1.000; 95% CI: 0.999 to 1.001; P = 0.951). We observed that previous vaccination against flu and reported adaptations to ensure continuity of HIV care during the COVID-19 outbreak significantly reduced the odds of PLWH developing flu-like symptoms during the COVID-19 outbreak. The use of tenofovir-containing ART regimen had no impact on the odds of developing flu-like symptoms among our participants.