HIV and SARS-CoV-2 Co-infection: Epidemiological, Clinical Features, and Future Implications for Clinical Care and Public Health for People Living with HIV (PLWH) and HIV Most-at-Risk Groups

Abstract Background With the indiscriminate spread of COVID-19 globally, many populations are experiencing negative consequences such as job loss, food insecurity, and inability to manage existing medical conditions and maintain preventive measures such as social distancing and personal preventative equipment. Some of the most disadvantaged in the COVID-19 era are people living with HIV/AIDS and other autoimmune diseases. Discussion As the number of new HIV infections decrease globally, many subpopulations remain at high risk of infection due to lack of or limited access to prevention services, as well as clinical care and treatment. For persons living with HIV or at higher risk of contracting HIV, including persons who inject drugs or men that have sex with men, the risk of COVID-19 infection increases if they have certain comorbidities, are older than 60 years of age, and are homeless, orphaned, or vulnerable children. The risk of COVID-19 is also more significant for those that live in Low- and Middle-Income Countries, rural, and/or poverty-stricken areas. An additional concern for those living the HIV is the double stigma that may arise if they also test positive for COVID-19. As public health and health care workers try to tackle the needs of the populations that they serve, they are beginning to realize the need for a change in the infrastructure that will include more efficient partnerships between public health, health care, and HIV programs. Conclusion Persons living with HIV that also have other underlying comorbidities are a great disadvantage from the negative consequences of COVID-19. For those that may test positive for both HIV and COVID-19, the increased psychosocial burdens stemming from stress and isolation, as well as, experiencing additional barriers that inhibit access to care, may cause them to become more disenfranchised. Thus, it becomes very important during the current pandemic for these challenges and barriers to be addressed so that these persons living with HIV can maintain continuity of care, as well as, their social and mental support systems.

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Uptake and trends in ordering of funded hepatitis B immunisation for priority populations in Victoria, Australia, 2013–2014

Sexual Health ◽

10.1071/sh16002 ◽

2017 ◽

Vol 14 (2) ◽

pp. 188

Author(s):

Jennifer H. MacLachlan ◽

Benjamin C. Cowie

Keyword(s):

At Risk ◽

Hepatitis B ◽

Risk Groups ◽

Hepatitis B Vaccine ◽

People Living With Hiv ◽

Department Of Health ◽

Priority Populations ◽

Living With Hiv ◽

The Impact ◽

Over Time

Background The Department of Health and Human Services in Victoria provides funded hepatitis B vaccine to many priority groups at risk of acquiring infection. We aimed to determine the uptake of vaccine ordering for at-risk groups over time, to assess any trends and identify any gaps in prevention of hepatitis B for those at risk. Methods: Routinely collected administrative data regarding the indication for vaccine ordered by practitioners were analysed for the period June 2013 to December 2014. Number of doses and courses distributed was determined and compared with the estimated size of the priority populations. Results: During the 18-month period assessed, 20 498 doses of funded hepatitis B vaccine were ordered, equating to ~5700 complete courses, with the overall number of orders per quarter increasing between 2013 and 2014. The most common indication was being a household or sexual contact of people living with hepatitis B (2803 courses, 49.2% of the total), equating to approximately one course per new chronic hepatitis B notification. The remaining doses were largely distributed to people living with HIV (648 courses, 11.4%), people living with hepatitis C (621 courses, 10.9%), and people who inject drugs (594 courses, 10.4%). Conclusions: This analysis demonstrates that access to hepatitis B immunisation among priority populations appears to have increased in Victoria during 2013–14, however it could still be improved. Continued assessment of these data over time will be important to measure the impact of interventions on increasing the reach of the funded vaccine program.

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HIV Viral Suppression among People Living with HIV on Antiretroviral Therapy in Haut-Katanga and Kinshasa Provinces of Democratic Republic of Congo

Healthcare ◽

10.3390/healthcare10010069 ◽

2021 ◽

Vol 10 (1) ◽

pp. 69

Author(s):

Gulzar H. Shah ◽

Lievain Maluantesa ◽

Gina D. Etheredge ◽

Kristie C. Waterfield ◽

Osaremhen Ikhile ◽

...

Keyword(s):

Public Health ◽

Antiretroviral Therapy ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

Clinical Care ◽

Hiv Care ◽

People Living With Hiv ◽

National Guidelines ◽

Republic Of Congo ◽

Living With Hiv

Human immunodeficiency virus (HIV) infections and less-than-optimal care of people living with HIV (PLHIV) continue to challenge public health and clinical care organizations in the communities that are most impacted by HIV. In the era of evidence-based public health, it is imperative to monitor viral load (VL) in PLHIV according to global and national guidelines and assess the factors associated with variation in VL levels. Purpose: This study had two objectives—(a) to describe the levels of HIV VL in persons on antiretroviral therapy (ART), and (b) to analyze the significance of variation in VL by patients’ demographic and clinical characteristics, outcomes of HIV care, and geographic characteristics of HIV care facilities. Methods: The study population for this quantitative study was 49,460 PLHIV in the Democratic Republic of Congo (DRC) receiving ART from 241 CDC-funded HIV/AIDS clinics in the Haut-Katanga and Kinshasa provinces of the DRC. Analysis of variance (ANOVA) was performed, including Tamhane’s T2 test for pairwise comparisons using de-identified data on all patients enrolled in the system by the time the data were extracted for this study by the HIV programs in May 2019. Results: The VL was undetectable (<40 copies/mL) for 56.4% of the patients and 24.7% had VL between 40 copies/mL and less than 1000 copies per mL, indicating that overall, 81% had VL < 1000 and were virologically suppressed. The remaining 19% had a VL of 1000 copies/mL or higher. The mean VL was significantly (p < 0.001) higher for males than for females (32,446 copies/mL vs. 20,786, respectively), persons <15 years of age compared to persons of ages ≥ 15 years at the time of starting ART (45,753 vs. 21,457, respectively), patients who died (125,086 vs. 22,090), those who were lost to follow-up (LTFU) (69,882 vs. 20,018), those with tuberculosis (TB) co-infection (64,383 vs. 24,090), and those who received care from urban clinics (mean VL = 25,236) compared to rural (mean VL = 3291) or semi-rural (mean VL = 26,180) clinics compared to urban. WHO clinical stages and duration on ART were not statistically significant at p ≤ 0.05 in this cohort. Conclusions: The VL was >1000 copies/mL for 19% of PLHIV receiving ART, indicating that these CDC-funded clinics and programs in the Haut-Katanga and Kinshasa provinces of DRC have more work to do. Strategically designed innovations in services are desirable, with customized approaches targeting PLHIV who are younger, male, those LTFU, with HIV/TB co-infection, and those receiving care from urban clinics.

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Seventy Years of Tuberculosis Prevention: Efficacy, Effectiveness, Toxicity, Durability, and Duration

American Journal of Epidemiology ◽

10.1093/aje/kwz172 ◽

2019 ◽

Vol 188 (12) ◽

pp. 2078-2085 ◽

Cited By ~ 2

Author(s):

Nicole Salazar-Austin ◽

David W Dowdy ◽

Richard E Chaisson ◽

Jonathan E Golub

Keyword(s):

Public Health ◽

High Risk ◽

Risk Groups ◽

Preventive Therapy ◽

People Living With Hiv ◽

Human History ◽

Household Contacts ◽

Tuberculosis Prevention ◽

School Of Public Health ◽

Living With Hiv

Abstract Tuberculosis (TB) has been a leading infectious cause of death worldwide for much of human history, with 1.6 million deaths estimated in 2017. The Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health has played an important role in understanding and responding to TB, and it has made particularly substantial contributions to prevention of TB with chemoprophylaxis. TB preventive therapy is highly efficacious in the prevention of TB disease, yet it remains underutilized by TB programs worldwide despite strong evidence to support its use in high-risk groups, such as people living with HIV and household contacts, including those under 5 years of age. We review the evidence for TB preventive therapy and discuss the future of TB prevention.

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High prevalence of sexually transmitted coinfections among at-risk people living with HIV

Journal of the Formosan Medical Association ◽

10.1016/j.jfma.2020.12.008 ◽

2020 ◽

Author(s):

Kuan-Yin Lin ◽

Hsin-Yun Sun ◽

Tai-Fen Lee ◽

Yu-Chung Chuang ◽

Un-In Wu ◽

...

Keyword(s):

At Risk ◽

People Living With Hiv ◽

Sexually Transmitted ◽

High Prevalence ◽

Living With Hiv

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Limited Utility of Cardiovascular Risk Scores for People Living with HIV in Malawi

10.1101/2020.08.01.20166462 ◽

2020 ◽

Author(s):

Chia Goh ◽

Henry Mwandumba ◽

Alicja Rapala ◽

Willard Tingao ◽

Irene Sheha ◽

...

Keyword(s):

Risk Score ◽

Low Income ◽

Intima Media Thickness ◽

Risk Groups ◽

Carotid Intima Media Thickness ◽

Endothelial Damage ◽

Risk Scores ◽

People Living With Hiv ◽

Cvd Risk ◽

Living With Hiv

HIV is associated with increased cardiovascular disease (CVD) risk. Despite the high prevalence of HIV in low income subSaharan Africa, there are few data on the assessment of CVD risk in the region. In this study, we aimed to compare the utility of existing CVD risk scores in a cohort of Malawian adults, and assess to what extent they correlate with established markers of endothelial damage: carotid intima media thickness (IMT) and pulse wave velocity (PWV). WHO/ISH, SCORE, FRS, ASCVD, QRISK2 and D:A:D scores were calculated for 279 Malawian adults presenting with HIV and low CD4. Correlation of the calculated 10year CVD risk score with IMT and PWV was assessed using Spearmans rho. The median (IQR) age of patients was 37 (31 to 43) years and 122 (44%) were female. Median (IQR) blood pressure was 120/73mmHg (108/68 to 128/80) and 88 (32%) study participants had a new diagnosis of hypertension. The FRS and QRISK2 scores included the largest number of participants in this cohort (96% and 100% respectively). D:A:D, a risk score specific for people living with HIV, identified more patients in moderate and high risk groups. Although all scores correlated well with physiological markers of endothelial damage, FRS and QRISK2 correlated most closely with both IMT [r2 0.51, p<0.0001 and r2 0.47, p<0.0001 respectively] and PWV [r2 0.47, p<0.0001 and r2 0.5, p<0.0001 respectively]. Larger cohort studies are required to adapt and validate risk prediction scores in this region, so that limited healthcare resources can be effectively targeted.

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Examining the role of vocational rehabilitation on access to care and public health outcomes for people living with HIV/AIDS

Disability and Rehabilitation ◽

10.3109/09638288.2013.837968 ◽

2014 ◽

Vol 36 (14) ◽

pp. 1203-1210 ◽

Cited By ~ 10

Author(s):

Liza Conyers ◽

K. B. Boomer

Keyword(s):

Public Health ◽

Health Outcomes ◽

Access To Care ◽

Vocational Rehabilitation ◽

People Living With Hiv ◽

Living With Hiv ◽

Hiv Aids

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Evolving Toward Shared HIV Care Using the Champlain BASE eConsult Service

MDM Policy & Practice ◽

10.1177/2381468319868216 ◽

2019 ◽

Vol 4 (2) ◽

pp. 238146831986821

Author(s):

Claire E. Kendall ◽

Janessa E. Porter ◽

Esther S. Shoemaker ◽

Rachel Seoyeon Kang ◽

Michael Fitzgerald ◽

...

Keyword(s):

At Risk ◽

Primary Care Providers ◽

Question Type ◽

Hiv Care ◽

People Living With Hiv ◽

Local Health ◽

Care Providers ◽

Patients At Risk ◽

Survey Responses ◽

Living With Hiv

Background. Electronic consultation (eConsultation) is a potential strategy to improve access to specialist expertise and facilitate collaborative care models. The Champlain BASE eConsult service allows for asynchronous communication between primary care providers (PCP) and specialists on a secure, web-based system. HIV experts accessible include HIV physician specialists, HIV pharmacists, and social workers with expertise in HIV. Objective. This study aims to describe the use, value, and utility of this eConsultation service in the care of people living with HIV and to characterize the common question types and clinical topics asked by PCPs. Methods. We analyzed the data from eConsults sent to the HIV specialty group in Ontario’s Champlain Local Health Integration Network between February 2015 and December 2017. Usage data and close-out survey responses were analyzed using descriptive statistics, eConsults were classified using a predefined list of validated taxonomy, and a thematic analysis was performed on the consultation logs to identify common clinical themes. Results. Among the 46 eConsults, the most common question type related to drug treatment (58.7%, n = 27) and management (19.6%, n = 9). The main clinical themes involved the care of significant complexities in people living with HIV, such as comorbidities and drug interactions, and suggestions of coordinated patient care. As well, eConsult was used for advice regarding pre-exposure prophylaxis for HIV-negative patients at risk of HIV infection. PCPs highly valued the eConsult service (average rating 4.8/5). Conclusion. Overall, this study demonstrates that eConsult provides an efficient and valuable service to PCPs caring for patients living with or at risk for HIV by improving access to HIV specialists and facilitating the delivery of team-based comprehensive care.

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Social Distancing to Mitigate COVID-19 Risks Is Associated With COVID-19 Discriminatory Attitudes Among People Living with HIV

Annals of Behavioral Medicine ◽

10.1093/abm/kaaa074 ◽

2020 ◽

Vol 54 (10) ◽

pp. 728-737

Author(s):

Marcie Berman ◽

Lisa A Eaton ◽

Ryan J Watson ◽

J L Andrepont ◽

Seth Kalichman

Keyword(s):

Social Sciences ◽

Public Health ◽

Severe Acute Respiratory Syndrome ◽

Ongoing Study ◽

People Living With Hiv ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Immune Systems ◽

Social Distancing ◽

Living With Hiv

Abstract Background Severe acute respiratory syndrome coronavirus-2, the virus that causes COVID-19, is an emerging pandemic with heightened concerns for people with compromised immune systems, including people living with HIV. Purpose In the absence of a vaccine, public health messaging to mitigate risks for COVID-19 primarily focuses on social distancing. Because people living with HIV commonly experience mistreatment associated with HIV, their response to social distancing may be complicated by psychosocial attitudes associated with COVID-19. Methods To evaluate these relationships, we conducted a rapid-response, cross-sectional survey with people living with HIV (N = 149) to assess social distancing practices, COVID-19 discriminatory attitudes, COVID-19 xenophobic attitudes, HIV microaggressions, and concern over contracting COVID-19. Data were collected from participants enrolled in a larger ongoing study between March 30, 2020 and April 17, 2020. Results Results indicated that choosing to socially distance to reduce COVID-19 exposure was associated with COVID-19 discriminatory attitudes, concerns of contracting COVID-19, and identifying as transgender. Likewise, social distancing imposed by others (e.g., cancelations and restrictions) was associated with concerns of contracting COVID-19. Conclusions Findings demonstrate that social distancing measures are related to concerns of contracting the virus and discriminatory attitudes toward those who are presumed to be living with COVID-19. These potentially negative psychosocial attitudes toward people perceived to have COVID-19 echo the discriminatory actions and attitudes that we continue to observe in HIV social sciences research.

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