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One study finds that HIV suppression is less common in the era of COVID-19

Potent combination HIV treatment (ART) has two main benefits—improving a person’s health and preventing the spread of HIV. When a person with HIV initiates and then continues to take ART as prescribed, the amount of HIV in the blood eventually falls to very low levels. These low levels (usually less than 40 or 50 copies/mL of blood) are commonly called “undetectable.” Studies have found that maintaining the use of ART so that HIV is suppressed generally results in better clinical and laboratory measures of health. These effects of ART are so profound that scientists increasingly expect many ART users to have near-normal life expectancy. Also, studies have found that HIV-positive people who maintain an undetectable viral load (thanks to ART) do not pass on HIV to their sexual partners.

Thus, HIV testing, initiation of ART, and viral load suppression and monitoring are key metrics in personal and public health efforts to gain control of the HIV epidemic.

A new pandemic

In late 2019, a new virus called SARS-CoV-2 emerged in East Asia and quickly spread around the world. This virus belongs to the family of viruses called coronaviruses. Infection with SARS-CoV-2 causes symptoms and complications collectively called COVID-19.

The coronavirus pandemic has caused widespread social and economic disruption brought about by the need to curtail the spread of the virus with measures such as physical distancing and isolation. Access to and delivery of routine healthcare services has also been affected by the pandemic.

In San Francisco

A team of researchers in San Francisco analysed healthcare data collected from an HIV clinic (called “Ward 86”) that provides services to people affected by what researchers termed “a high prevalence of mental illness, substance use and unstable housing.”

As the first wave of the pandemic hit the state of California in the spring of 2020, clinic staff shifted many in-person visits to telephone appointments where possible. They stated that they also “facilitated viral load testing via rapid laboratory visits, with at least quarterly monitoring.”

Researchers compared clinic data collected in two periods:

  • December 1, 2019 – February 29, 2020
  • April 1, 2020 – April 30, 2020

Results

In 2019, the clinic had about 1,836 in-person visits each month from patients. Researchers found that, on average, about 19% of people had an unsuppressed viral load at least once. About 16% of patients were homeless.

In April 2020, 54% of appointments were conducted over the telephone. The researchers stated that “homeless individuals were offered telehealth for only 32% of visits.” They also stated that homeless people were more likely to keep telephone appointments during the pandemic compared to the pre-pandemic era.

Changes to viral load

In April 2020, researchers found that about 31% of patients had a detectable viral load.

Factors linked to an increased risk for a detectable viral load were as follows:

  • being younger than 35 years old
  • being homeless
  • being black

According to the researchers, part of the reason for the increase in detectable viral loads might have been because “telehealth visits, while offering greater patient convenience, may lead to less access to clinic-based social support services essential to achieving viral suppression among vulnerable groups.” They also stated that “homeless individuals at [our clinic] had higher odds of unsuppressed viral loads [during the pandemic] despite higher visit attendance.”

Bear in mind

The present study is a good start at documenting the changes that are happening among HIV-positive people in the coronavirus pandemic. The loss of viral suppression will likely have an impact on individual health in the medium- and long-term and on the spread of HIV. Indeed, San Francisco’s public health department has stated that there has been an increase in new infections. The research team issued a call to action, stating that “measures to counteract the effect of COVID-19 on HIV care outcomes are urgently needed.”

—Sean R. Hosein

REFERENCE:

Spinelli MA, Hickey MD, Glidden DV, et al. Viral suppression rates in a safety-net HIV clinic in San Francisco destabilized during COVID-19. AIDS. 2020; in press.