Real-life findings on the impact of the COVID-19 pandemic on HIV care

Abstract

The ongoing COVID-19 pandemic is rapidly reshaping the organization of healthcare systems worldwide, prompting the creation of COVID-19–dedicated wards and services at the expense of pre-existing structures. European countries are now facing the “second wave” of the COVID-19 epidemic, with increasing numbers of cases and deaths; hence, people with chronic conditions, including those living with HIV (PLWHIV), are struggling to maintain their routine disease management, resulting in missed medical visits and the risk of lower adherence to treatment. In our clinical center in Rome, Italy, we conducted a retrospective study aimed at observing how PLWHIV were followed-up during the “first wave” of the COVID-19 epidemic in the country and during the national lockdown from March 9 to May 28, 2020. We analyzed all treatment-experienced, virologically suppressed PLWHIV who had had at least one visit between March 10 and June 1, 2020, and collected viroimmunological parameters. We compared this group of PLWHIV with the patients observed over the same period in 2019. Our primary aim was to assess the rate of virological failures (VF, defined as two consecutive HIVRNA ≥ 50 copies/mL or a single HIV-RNA ≥ 1000 copies/mL). Predictors of VF were assessed using Cox regression analysis. Regarding the 2020 group, data from 341 patients were analyzed: 235 (68.9%) were males, with a median age of 54 years (Interquartile range = 46–60), a median time from HIV diagnosis of 16.1 years (IQR = 7.6–23.8), and a median time of virological suppression of 82.4 months (IQR = 31.1–142.9). With regard to antiretroviral therapy, 149 patients (43.7%) were on a 2NRTI+INI regimen, 74 (21.7%) were on 2NRTI+NNRTI, 70 (20.5%) were on a dual regimen with DTG+3 TC, 22 (6.5%) were on a regimen with 2NRTI+bPI, and 26 (7.6%) were on other regimens. Regarding the 2019 group, data from 1066 patients were available. All patients’ characteristics and differences between groups are shown in Table 1. During 184.3 Patient-Years of Follow-Up (PYFU) of the 2020 group, we observed 23 VF, a rate of 12.5 per 100 PYFU. In patients experiencing VF, we performed a genotypic test to investigate acquired mutations: among the 23 analyzed individuals, two of them, both on a 2NRTI+raltegravir (RAL) strategy, presented newly discovered mutations (one had both the 138K and the 148R mutations and the other had the 155H mutation) conferring resistance to RAL. Interestingly, patients on a dual regimen had significantly less probability of showing VF compared to patients on 3+ drug regimens: 6-month probability of remaining virologically suppressed was 98.8% vs 90.5%, respectively (log-rank p = 0.031). In the calendar period of 2019, we observed 50 VF during 675 PYFU, a rate of 7.4 per 100 PYFU. Time of virological suppression (aHR = 0.96 per month longer, 95%CI 0.95–0.98, p < 0.001) emerged as the only