Has COVID-19 changed the approach to HIV diagnosis?

Mazzitelli, Maria; Ciccullo, Arturo; Baldin, Gianmaria; Cauda, Roberto; Rusconi, Stefano; Giacomelli, Andrea; Oreni, Letizia; Borghi, Vanni; Mussini, Cristina; Guaraldi, Giovanni; Sterrantino, Gaetana; Lagi, Filippo; Candelaresi, Bianca; Cirioni, Oscar; Vito, Andrea De; Rossetti, Barbara; Torti, Carlo; Giambenedetto, Simona Di

doi:10.1097/md.0000000000027418

Cited by 11 publications

(13 citation statements)

References 9 publications

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“…Concerning risk of transmission, we found a decreasing rate of new HIV infections in MSM which was also observed in an Italian cohort during the ongoing COVID-19 pandemic [12]. This could be due to reduced contacts during lockdown as well as the fewer possibilities for testing mentioned earlier, which is more widespread and implemented in this risk group.…”

Section: Discussionsupporting

confidence: 73%

Impact of COVID‐19 on HIV late diagnosis in a specialized German centre

et al. 2022

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Background: The ongoing COVID-19 pandemic has been impeding HIV diagnosis and treatment worldwide. Data on the impact of COVID-19 on late diagnosis (LD) in Germany are lacking. Here we present novel data of a singlecentre German HIV cohort assessing LD during COVID-19. Methods: This is a non-interventional, single-centre retrospective cohort assessing the rate of LD comparing HIV diagnoses pre-COVID-19 with those during the COVID-19 pandemic. New diagnoses between 1 January 2019 and 1 February 2020 were classified as pre-COVID-19, and diagnoses between 1 February 2020 and 1 October 2021 were classified as during COVID-19. Results: Between 1 January 2019 and 1 October 2021, 75 patients presented with newly diagnosed HIV infection, 34 pre-COVID-19 and 41 during COVID-19. LD increased to 83% (n = 34/41) during COVID-19 versus 59% (n = 20/34) pre-COVID-19, and CDC stage C3 rose to 44% (n = 18) versus 27%. Hospitalization rate increased to 49% (n = 20) during COVID-19 versus

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Section: Discussionsupporting

confidence: 73%

Impact of COVID‐19 on HIV late diagnosis in a specialized German centre

et al. 2022

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“…Due to shifting healthcare restrictions, lockdowns and travel bans worldwide, a large number of migrant populations might not have been able to reach our ED. The impact of the pandemic reducing the number of HIV diagnoses has also been reported by other groups in multiple countries [48–53]. Regarding late diagnosis and missed opportunities, data from 12 September 2018 to 11 September 2019 are unaffected by the COVID‐19 pandemic and still show a reduction in late diagnosis, mean number of previous healthcare encounters and percentage of patients with at least one healthcare encounter, all of which hints favourably at the benefit of our intervention.…”

Section: Discussionsupporting

confidence: 70%

“…Regarding late diagnosis and missed opportunities, data from 12 September 2018 to 11 September 2019 are unaffected by the COVID‐19 pandemic and still show a reduction in late diagnosis, mean number of previous healthcare encounters and percentage of patients with at least one healthcare encounter, all of which hints favourably at the benefit of our intervention. Given the impact of the COVID‐19 pandemic on worldwide detection of HIV in general, we can speculate about an increase in the late diagnosis rate in the coming years, but this has not been reported so far [ 48 , 49 , 50 , 51 , 52 , 53 ]. Despite these limitations, our study demonstrated a robust methodology to generate essential HIV diagnoses and epidemiology data.…”

Section: Discussionmentioning

confidence: 99%

Increasing HIV early diagnosis by implementing an automated screening strategy in emergency departments

Pinto¹,

Gorgulho²,

Esteves³

et al. 2022

HIV Medicine

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Introduction: Late HIV diagnosis is associated with increased morbidity, mortality and risk of onward transmission. Increasing HIV early diagnosis is still a priority. In this observational study with historical control, we determined the impact of an opportunistic HIV screening strategy in the reduction of late diagnosis and missed opportunities for earlier diagnosis. Methods: The screening programme was implemented in the emergency department (ED) of the Hospital de Cascais between September 2018 and September 2021. Eligible patients were aged 18-64 years, with no known HIV diagnosis or antibody testing performed in the previous year, and who required blood work for any reason. Out of the 252 153 emergency visits to the ED, we identified 43 153 (17.1%) patients eligible for HIV testing. Among the total population eligible for the screening, 38 357 (88.9%) patients were ultimately tested for HIV. Impact of the ED screening was determined by analysing late diagnosis in the ED and missed opportunities at different healthcare settings 3 years before and 3 years after the start of the ED screening. Results: After 3 years of automated HIV ED testing, we found 69 newly diagnosed HIV cases (54% male, 39% Portuguese nationals, mean age 40.5 years). When comparing the characteristics of HIV diagnoses made in the ED, we observed a significant reduction in the number of people with late HIV diagnosis before and after implementation of the screening programme (78.4% vs. 39.1%, respectively; p = 0.0291). The mean number of missed opportunities for diagnosis also fell (2.6 vs. 1.5 annual encounters with the healthcare system per patient, p = 0.0997). Conclusions: People living with HIV in Cascais and their providers miss several opportunities for earlier diagnosis. Opportunistic screening strategies in settings previously deemed to be unconventional, such as EDs, are feasible and effective in mitigating missed opportunities for timely HIV diagnosis.Inês Vaz-Pinto and Ana Gorgulho contributed equally to this work.

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“…We believe that in our study the higher proportion of participants who withdrew because of adverse events may be somewhat related to the COVID-pandemic period during which the study was conducted. It is known how COVID-19 had an important impact on the “HIV world” (involving prevention, diagnosis, and treatment), and it is still also debated whether people with HIV have a poorer prognosis than the general population [ 32 , 33 , 34 ]. The modified lifestyle due to the lockdown curfew, the fear of self-isolation with the feelings of more stress and anxiety may have had a negative impact on the patient’s psychosocial health and may have triggered an increased perception of severe side effects related to the new drug regimen.…”

Section: Discussionmentioning

confidence: 99%

Viro-Immunological, Clinical Outcomes and Costs of Switching to BIC/TAF/FTC in a Cohort of People Living with HIV: A 48-Week Prospective Analysis

et al. 2022

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To date, therapeutic switches are performed to reduce and prevent toxicity, improve adherence, promote virological control, and save costs. Drug switches are a daily challenge in the management of people living with HIV (PLWH), especially in those with multiple comorbidities and on polypharmacy. The objectives of this prospective analysis were: (I) to evaluate the viro-immunological efficacy of BIC/FTC/TAF in a cohort of PLWH who switched to this regimen from any other previous, at the Infectious and Tropical Diseases Unit of the Padua University Hospital; (II) to assess the impact on body weight, lipids, and renal function parameters at week 48; and (III) to evaluate daily costs changes, adherence, and the rate and causes of discontinuation of the regimen. We included all adult PLWH who switched to BIC/FTC/TAF from 1 February 2020 to 31 October 2021. We collected demographic, clinical, and laboratory data at baseline and week 48 after the switch. In addition, the estimated cART-related cost changes over the follow-up period were calculated. Over the study period, 290 individuals who switched to BIC/FTC/TAF, 76.9% were males, with a median age of 52 years, and 94.8% had an undetectable baseline HIV viremia. After a median time of 35 days (IQR: 1–55), 41 (14.1%) individuals discontinued the regimen. Factors significantly associated with discontinuation were switching from dual regimens, and neurological disorders. At week 48, we detected a significant increase in body weight, BMI, CD4 T-cell count, and CD4/CD8 ratio, and a significant reduction in triglycerides and costs; all patients had undetectable HIV RNA. Our results showed that switching to BIC/FTC/TAF may favor slightly immunological recovery and cost saving (−4.2 EUR/day from baseline to week 48, equivalent to a mean saving of 1533 EUR/year/person). The reduction in triglycerides does not appear to be clinically relevant, even if statistically significant, nor do both the increase in body weight and BMI (+1 kg and +0.29 BMI, respectively) and the increase in CD4 T-cell count (+45 cells/mmc). Further studies are needed to confirm our results.

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Has COVID-19 changed the approach to HIV diagnosis?

Cited by 11 publications

References 9 publications

Impact of COVID‐19 on HIV late diagnosis in a specialized German centre

Impact of COVID‐19 on HIV late diagnosis in a specialized German centre

Increasing HIV early diagnosis by implementing an automated screening strategy in emergency departments

Viro-Immunological, Clinical Outcomes and Costs of Switching to BIC/TAF/FTC in a Cohort of People Living with HIV: A 48-Week Prospective Analysis

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