key: cord-0753916-c51v50o7
authors: Restuccia, Daniela; Carrión-Nessi, Fhabián S.; Omaña-Ávila, Óscar D.; Mendoza-Millán, Daniela L.; Mejía-Bernard, Mario D.; Marcano-Rojas, María V.; Quintero, Adriana; Gasparini, Sebastián; Chacón, Fabián R.; Basso, Jorge G.; Rodríguez, Verónica A.; Forero-Peña, David A.
title: Prevalence of undiagnosed HIV in Venezuelan patients with suspected COVID-19 during the first wave: A complex syndemic
date: 2021-11-14
journal: Travel Med Infect Dis
DOI: 10.1016/j.tmaid.2021.102207
sha: 74c91bd3323270ffe397e9a350cd9d1a59d7f69d
doc_id: 753916
cord_uid: c51v50o7

nan

The impact of the COVID-19 pandemic is likely to be deeper in resource-limited settings, including Venezuela, where its effects are compounded by the country's complex humanitarian crisis, inadequately resourced health systems, and concurrent HIV epidemics [1] . There is growing concern that COVID-19 will lead to the disruptions for HIV testing and treatment services, which could result in excess HIV-related deaths and onward transmission, jeopardizing the fulfillment of the first UNAIDS global 90-90-90 target that 90% of all people living with HIV will know their status [2] . Here we determined the prevalence of undiagnosed HIV in suspected COVID-19 patients during the first wave, as well as their clinical-epidemiological characteristics, at the main sentinel hospital in Caracas, Venezuela.

We cross-sectionally analyzed 118 consecutive suspected COVID-19 cases (according to WHO guidelines) [3] in the respiratory triage tent of the "Hospital Universitario de Caracas", Venezuela, between May and August 2020. Ethics committee approval was obtained from the "Centro Nacional de Bioética", Venezuela (CIBI-CENABI-11/2020). After signing the informed consent, clinical-epidemiological information was obtained from all patients. HIV testing was performed using the ABON™ HIV 1/2/O Tri-Line HIV rapid test device (ABON Biopharm Hangzhou Co., Ltd.). 4th-gen-ELISA confirmed positive and discordant results, initiating ART immediately in positive patients. Categorical variables were presented as frequencies and were compared using Fisher's exact or Yates's chi-squared tests. Continuous variables were presented as mean (SD) or median [IQR] and were compared using Student's t-test or median test. All statistical analyses were performed using SPSS 25, with a 0.05 significance level.

Out of 118 COVID-19 patients, 5 (prevalence rate = 4.24 × 100 patients) were HIV positive. Patients' mean age was 41 (SD 14), mostly female (57.1%), from Capital District (80.5%) and employed (43.2%). Compared to HIV-negative, a higher proportion of HIV-positive patients were homosexual (p < 0.001), had sexual intercourse under the influence of alcohol/drugs in the last six months (p = 0.044), and had syphilis history (p < 0.001) ( Table 1) . Fever (67.8%), dry cough (65.3%), headache (63.6%), dyspnea (54.2%) and asthenia (52.5%) were the most common symptoms in all patients; the less common symptoms included weight loss (14.4%), dysphagia (14.4%), abdominal pain (13.6), lymphadenopathies (7,6%) and skin lesions (6.8%). A higher proportion of skin lesions and lymphadenopathies were found in HIVpositive patients compared to HIV-negative ones (80% vs. 3.5%, p < 0.001; 60% vs. 5.1%, p < 0.001; respectively).

Quarantine, social distancing, and community containment have reduced access to routine HIV testing and, thus, access to know their HIV status, which challenges completion of UNAIDS' first 90-90-90 target globally [4] . Furthermore, the healthcare focus on COVID-19 has neglected other pathologies such as HIV, contributing to a lower rate of people diagnosed early [4, 5] . Expanding HIV screening and linking it to COVID-19 care are important public health initiatives that should continue to be employed in the Venezuelan health system [6] . We recommend that the government, Venezuelan nongovernmental organizations, and international partners work together to maintain the continuity of HIV care during and after the COVID-19 pandemic, making a special effort to ensure the availability of routine HIV services and avoid their interruption and potential consequences [7] .

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

The authors declare no conflicts of interest. 

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