Changes in the profile of people seeking care in London, UK
Observational studies have generally reported similar results in HIV-positive and HIV-negative people who have been hospitalized with COVID-19. Further details can be found in the links below:
https://catie.ca/en/treatmentupdate/treatmentupdate-238/hiv-and-covid-19
A report of a change in the profile of people seeking care at a major HIV clinic in London, UK, has recently emerged.
Doctors at Chelsea and Westminster Hospital noticed an increased number of HIV-positive people who sought care because of AIDS-related complications.
The doctors compared HIV-related hospital admissions in two periods: July to October 2019 and the same months in 2020.
Key findings – focus on AIDS in hospitalized patients
Although there were fewer admissions in 2020 than in 2019, doctors found a large increase in the proportion of hospitalization for AIDS-related causes. Here is a comparison of the two years:
2019
27% of hospitalizations were due to AIDS-related causes such as the following:
- cancers – 48%
- life-threatening infections – 52%
2020
54% of hospitalizations were due to AIDS-related causes such as the following:
- cancers – 28%
- life-threatening infections – 72%
Laboratory testing of blood samples found a trend toward increasing immunodeficiency in hospitalized HIV-positive people in 2020 compared to 2019.
2019
- newly diagnosed HIV infections – 16%
- CD4+ cell count among newly diagnosed people – 157 cells/mm3
2020
- newly diagnosed HIV infections – 16%
- CD4+ cell count among newly diagnosed people – 63 cells/mm3
There was also a trend to higher viral loads among hospitalized patients in 2020 compared to 2019.
The differences in the types of life-threatening infections/complications between the two study periods is too small to draw statistical comparisons. However, it was striking that in 2019 two out of 80 HIV-positive people (3%) had severe problems with memory and thinking clearly compared to five out of 48 people (10%) who were diagnosed with HIV in 2020. It is possible that this difference in the proportion of people with severe memory and thinking problems was due to chance. Yet, in an era of widely available HIV testing and effective treatment in a high-income country, people who were seeking care clearly had HIV-related neurocognitive impairment. Such problems were common in the time before potent combination HIV treatment became available (prior to 1996).
What is going on?
It is clear that a shift toward the development of more severe HIV-related immune deficiency has occurred among some people in London in the current era. Hospitalized patients were seriously ill. The research team stated that the shift in the profile of illness of patients is due to one or more of the following issues:
- “difficulty accessing healthcare”
- “reluctance to attend healthcare facilities during the first wave of the COVID-19 pandemic and the inevitable lockdown”
A similar trend—reluctance to access healthcare—has been reported among some HIV-negative people in different parts of the world during the initial wave of the pandemic.
The report from Chelsea and Westminster Hospital underscores the severe impact of the indirect effects of the COVID-19 pandemic on some people’s access to HIV testing, care and treatment. It also shows how deaths among HIV-positive people may arise in the pandemic era—from AIDS-related causes and not from COVID-19.
—Sean R. Hosein
Resources
HIV and COVID-19 – TreatmentUpdate 232
New York State assesses the impact of COVID-19 on HIV-positive people – CATIE News
REFERENCE:
Bell N, Bracchi M, Dalla Pria A, et al. Indirect HIV morbidity and mortality due to COVID-19. Clinical Infectious Diseases. 2021; in press.