, Coronavirus disease 2019 (COVID-19) has been spreading worldwide, and the outbreak was declared as a pandemic by World Health Organization on 12 March 2020. 1 Clinical studies have indicated that the spectrum of symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection ranges from mild (81%) to critical (5%). Severe illness (14%) and mortality (2.3%) predominantly occur in adults with older age or underlying medical comorbidities such as cardiovascular disease, diabetes mellitus, chronic lung disease, hypertension, cancer, and also severe obesity. 2,3 Approximately 37.9 million people living with HIV (PLHIV) worldwide are at risk of COVID-19. 4 Because of antiretroviral therapy (ART) and prevention policies, the number of PLHIV over the age of 50 years has increased dramatically and it is estimated that more than 1/5 of PLHIV globally are in this older age group. 5 And also, PLHIV have a higher risk of comorbid conditions compared with the general population because of chronic inflammation and immune activation from HIV, side effects of ART, and traditional risk factors such as alcohol, and tobacco use. 6
The aim of the study was to report the epidemiological profile of HIV-1 positive patients from, Istanbul, Turkey, which has one of the lowest HIV-1/AIDS prevalences in Europe. The patients were followed by ACTHIV-IST group which was established by the Infectious Diseases Departments of five teaching hospitals (three university hospitals and two public hospitals) in Istanbul, Turkey. The HIV-1 positive patients were added to the standard patient files in all of the centers; these files were then transferred to the ACTHIV-IST database in the Internet. A total of 829 naiv-untreated HIV-1 positive patients were chosen from the database. The number of male patients was 700 (84.4%) and the mean age of the patients was 37 years (range, 17-79). In our study group 348 (42%) of the patients were married and 318 (38.7%) of the patients were single. The probable route of transmission was heterosexual intercourse in 437 (52.7%) patients and homosexual intercourse in 256 (30.9%) patients. In 519 (62.6%) patients the diagnose was made due to a screening test and in 241 (29.1%) patients, the diagnose was made due to an HIV-related/non-related disease. The mean CD4+ T cell number in 788 of the patients was 357.8/mm(3) (±271.1), and the median viral load in 698 of the patients was 100,000 copies/mL (20-9,790,000). In Turkey, the number of HIV-1 positive patients is still low and to diagnose with a screening test is the most common way of diagnostic route.
Poorly educated individuals and men constituted the majority of the cases. Most women acquired the disease from their husbands. Considering the poor level of education among the patients we studied, effective educational programs should be developed to reduce the transmission of HIV. Although heterosexual intercourse was the most common route of transmission, 38% of the patients we studied reported male-to-male intercourse. This is markedly higher than the 9% rate of transmission by this route in Turkey.
Our results show a very high prevalence of bone mass reduction in Turkish HIV-infected patients. This study supports the importance of both HIV and antiretroviral therapy in low BMD.
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