Impact of Coronavirus Disease 2019 Epidemics on Prevention and Care for HIV and Other Sexually Transmitted Infections

Elisa de Lazzari; Alejandra Martínez-Mimbrero; Iván Chivite; Ana González-Cordón; Maria M. Mosquera; Montserrat Laguno; Josep Costa; Jordi Bosch; Jose L. Blanco; Miriam Álvarez-Martinez; Ainoa Ugarte; Alexy Inciarte; Lorena de la Mora; Berta Torres; Maria Martínez-Rebollar; Juan Ambrosioni; Emma Fernández; Juan Carlos Hurtado; Josep Mallolas; José M. Miró; María A. Marcos; Esteban Martínez

Disclosures

AIDS. 2022;36(6):829-838. 

In This Article

Abstract and Introduction

Abstract

Objective: To assess the impact of coronavirus disease 2019 (COVID-19) epidemics on the prevention and care for HIV and other sexually transmitted infections at a major reference centre providing preventive and clinical services in Catalonia, Spain.

Design: We retrospectively compared anonymized clinical and laboratory data from March to December 2020 vs. 2019.

Methods: Monthly clinical data on HIV preexposure and postexposure 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.

Results: There were less (↓28%, P = 0.003) but more advanced (mean CD4+ cells/μl 305 vs. 370, P < 0.001) HIV infections and more gonorrhoea (↑39%, P < 0.001) and chlamydia (↑37%, P < 0.001) infections in 2020 vs. 2019. In people with HIV, rates of HIV RNA less than 50 copies/ml remained stable (11 vs. 11%, P = 0.147) despite less scheduled visits (↓25%, P < 0.001). However, they had less antiretroviral prescription changes (↓10%, P = 0.018), worse plasma lipids [mean total cholesterol 190 vs. 185 mg/dl, P < 0.001;mean low-density lipoprotein (LDL) cholesterol 114 vs. 110 mg/dl, P < 0.001; mean triglycerides 136 vs. 125 mg/dl, P < 0.001; mean high-density lipoprotein (HDL) cholesterol 47 vs. 48 mg/dl, P = 006], and an excess of mortality (↑264%, P = 0.006) due in great part not only to COVID-19 but also to other causes.

Conclusion: In our setting, COVID-19 epidemics was associated with an increase in some prevalent sexually transmitted infections, with less but more advanced HIV infections, and with worse nonvirologic healthcare outcomes and higher mortality in people living with HIV.

Introduction

As of 12 October 2021, coronavirus disease 2019 (COVID-19) pandemic has caused more than 237 million confirmed cases and more than 4.8 million deaths worldwide.[1] Governments across the globe dictated severe physical and social contact restrictions aimed to drastically reduce viral transmission. Spain was one of the hardest hit countries at the beginning of the pandemic. Due to the exceptional nature of the situation, the Spanish government approved a first state of alarm on 14 March 2020 and imposed a strict home lockdown for all citizens with the exception of essential workers. With the slow but steady reduction in the number of cases, measures became more flexible from 11 May 2020 until 21 June 2020 when the first state of alarm officially ended. Unfortunately, during the summer, the number of cases progressively increased and the Spanish government declared a second state of alarm from 25 October 2020 until 9 May 2021. Mass vaccination against COVID-19 in Spain started on 27 December 2020.[2] Figure 1 shows the epidemic curve of laboratory-confirmed COVID-19 cases in Spain along with key milestones dates through 2020.

Figure 1.

Epidemic curve of laboratory-confirmed coronavirus disease 2019 cases in Spain along with key milestones dates. Adapted from: https://cnecovid.isciii.eS/covid19/#provincias. Accessed on 13 September 2021.

Beyond the direct toll on morbidity and mortality, SARS-CoV-2 pandemic have severely affected healthcare access and quality throughout the world. Healthcare resources were urgently and widely prioritized for SARS-CoV-2 diagnosis and clinical care of COVID-19 patients. As a result, the screening and the diagnosis for common chronic diseases was dramatically reduced and the availability of specific therapies was significantly delayed.[3,4] These factors ultimately led to increasing morbidity and mortality because of illnesses other than COVID-19.[5,6]

The emergence of SARS-CoV-2 epidemics may have also affected established measures for the prevention and diagnosis of HIV infection and other sexually transmitted diseases and the clinical care of HIV-infected patients, although data are limited.[7,8] The WHO warned that the access to HIV medicines could be severely impacted by COVID-19.[9] Mathematical models predicted an increase of HIV-related mortality if antiretroviral therapy supply was temporarily interrupted.[10,11] In Spain, telephone calls or electronic messaging kept minimum standards for HIV clinical care during lockdown, and antiretroviral therapy dispensation was facilitated with the development of home delivery programmes through the national public postal service, the national civil protection system, or private couriers.[12]

The Hospital Clinic is a community hospital for an area of influence with a population of 540 000 inhabitants in the city of Barcelona (Spain), and at the same time, operates as a reference care facility for specific diseases, such as HIV infection for the whole region of Catalonia (https://www.clinicbarcelona.org/en). The hospital currently provides ambulatory care, supply of antiretroviral therapy, and hospital admission if necessary for more than 6000 adults with HIV infection being the largest HIV care centre in Spain. It has been also providing HIV postexposure prophylaxis since 2003 and HIV preexposure prophylaxis as it was approved by the Spanish National Health System in November 2019. We aimed to assess the impact of COVID-19 epidemics on the prevention and clinical care of HIV infection and on the screening and diagnosis of HIV infection and other sexually transmitted diseases in the setting of Hospital Clinic of Barcelona.

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