key: cord-0993508-spg3qo9p
authors: Bell, Natasha; Bracchi, Margherita; Dalla Pria, Alessia; Nelson, Mark; Boffito, Marta
title: Indirect HIV morbidity and mortality due to COVID-19
date: 2021-02-13
journal: Clin Infect Dis
DOI: 10.1093/cid/ciab128
sha: 9dd23b64f12cd51877da183a6e8db7ff85557fde
doc_id: 993508
cord_uid: spg3qo9p

nan

A c c e p t e d M a n u s c r i p t Dear Editor, We read with interest the article [1] reporting similar outcomes from COVID-19 (corona virus infectious disease) in people living with HIV (PLWH), compared to matched controls (patients matched for age, sex, race/ethnicity, and calendar week of infection).

Whether COVID-19 morbidity and mortality are worse in PLWH is still unclear, as there are contrasting findings in the literature so far [2] [3] [4] . Further data from large observational trials will most likely be needed to fully understand where, and with what nuances, HIV infection stands as a risk factor in COVID-19.

On this note, we would like to offer a different perspective on the repercussions of the pandemic on PLWH, which goes beyond the direct effects of COVID-19 illness.

At the end of the first European COVID-19 wave, we noticed an increased number of PLWH being admitted with advanced HIV disease/AIDS. We examined HIV inpatient admissions at Chelsea and Westminster Hospital, London, UK (a tertiary referral centre for HIV/oncology), between July and October 2020, and compared them to those within the same period in 2019 (Table 1) .

Although there was a reduced absolute number of hospitalisations in the 2020 period, we observed a significantly higher proportions of admissions due to AIDS defining conditions (p=0.023). Whilst in 2019 26.5% of admissions were due to an AIDS defining illness (48% with an oncological diagnosis, 52% with an opportunistic infection, OI), in the 2020 period, over half of admissions were due to AIDS defining conditions (54%), with OIs and oncological diagnoses accounting for 72% and 28% of cases, respectively.

Moreover, among hospitalised patients in the 2020 period, we observed a higher proportion of new HIV diagnoses (16% vs 6%, p=0.073), lower CD4+ counts (median CD4+ 157 in 2019 versus 63 in 2020, p=0.0076) and higher HIV viral loads.

These findings suggest that patients presented to hospital with more advanced HIV disease in the second half of 2020, compared to the same time period in 2019. We believe this variation could be due to difficulty in accessing healthcare and/or reluctance to attend A c c e p t e d M a n u s c r i p t healthcare facilities during the first wave of the COVID-19 pandemic and the inevitable lockdown, as observed in the HIV negative population [5] [6] [7] .

Hence, when addressing the consequences of this pandemic on PLWH, it is important to consider the additional repercussions in accessing HIV testing and HIV diagnosis, and people linkage to care, ultimately translating into increased morbidity for PLWH.

Yours sincerely, The Authors.

Dr. Marta Boffito received speaker or advisory fees and research grants (to the Institution) from Gilead, ViiV, Cipla, Janssen, Teva, MSD, Thera, GSK, Mylan, and Novavax, outside the submitted work. All other authors have no potential conflicts to disclose. M a n u s c r i p t M a n u s c r i p t Legend to Table 1 :

A c c e p t e d M a n u s c r i p t 

Coronavirus 2019 and People Living With Human Immunodeficiency Virus: Outcomes for Hospitalized Patients

HIV infection and COVID-19 death: a population-based cohort analysis of UK primary care data and linked national death registrations within the OpenSAFELY platform. The Lancet HIV

Risk factors for COVID-19 death in a population cohort study from the Western Cape Province, South Africa

Polish Scientific AIDS Society Statement on risk of COVID-19 for people living with HIV (PLWH)

Why Aren't People Living with HIV at Higher Risk for Developing Severe Coronavirus Disease 2019 (COVID-19)? AIDS Patient Care STDS

Reduced attendances and admissions: lessons from the covid crisis

Reduced Rate of Hopsital Admissions for ACS during Covid-19

Outbreak in Northern Italy