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Assistant Professor, HIV Program
Department of Infectious Diseases
Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán
Mexico City, Mexico
Brenda E. Crabtree Ramírez, MD, has disclosed that she has received consulting fees from Janssen, MSD, and ViiV Healthcare.
It has now been more than a year since the first cases of COVID-19 appeared in Wuhan, China, in December 2019. The first case was reported in México on February 27, 2020. As of mid-February 2021, there have been more than 100 million confirmed cases globally, resulting in more than 2 million deaths. México, which has now reported more than 2 million confirmed cases and more than 180,000 deaths, has one of the lowest rates of daily tests administered but one of the highest positivity rates.
Global Impact on HIV Care
There is great concern about the impact and long-term consequences of the COVID-19 pandemic on the 40 million persons with HIV (PWH) worldwide. According to a July 2020 WHO survey of 144 countries, 36 countries reported a disruption in ART services, and an additional 73 countries reported a risk of ART service interruptions. A decade of progress in reducing HIV-associated death could be reversed, as evidenced by a recent modeling study that estimated a 6-month ART interruption could result in more than 500,000 additional deaths by diseases associated with AIDS.
Impact on PWH in México
In 2018, there was estimated to be 230,000 PWH in México. The pandemic has required the reallocation of resources to combat COVID-19. As a result, pre-exposure prophylaxis (PrEP) programs have not been implemented as planned, and HIV testing decreased by 33% in pregnant women and 59% in the overall population in the second trimester of 2020 compared with 2019. This reduction in testing will result in late HIV diagnosis and more patients presenting with severe disease and AIDS.
Patients have also experienced difficulties in ART accessibility and adherence, as lockdown measures resulted in limited access to medical care sought for non–COVID-19 reasons. According to the Ministry of Health, 5 of 10 PWH have reported difficulties obtaining their ART medication, and the percentage of PWH receiving ART decreased 2.42% from the beginning of 2020 to June 2020.
Patients have also reported mental health issues, including anxiety, depression, and fear. Finally, because many hospitals have been allocated to treat only COVID-19, patients with AIDS-related illness often cannot be hospitalized—this could have a serious impact on mortality.
Some actions have been taken since March 2020 to try to mitigate the effects of the pandemic on HIV care. These include providing patients with enough ART to cover 4-6 months of treatment and prioritizing admission and readmission of PWH requiring care when inpatient space is available. Telemedicine and virtual consultation have become a regular practice. However, telemedicine is not widely available, as it is challenging to implement in low-resource settings. National and international organizations have issued some recommendations to reduce the impact of COVID-19 on the continuum of HIV care. These include contact precautions to prevent PWH from becoming infected with COVID-19, especially for those with uncontrolled disease, continuation of ART, avoidance of ART regimen changes, and early ART initiation. An effort should be made in coordination with the government to ensure such recommendations can be implemented.
Evidence of unfavorable COVID-19 clinical outcomes in PWH has increased. However, PWH have not been given high priority to receive vaccination and continue to wait until healthcare workers and older individuals have been vaccinated. It is estimated that PWH will not be eligible for the COVID-19 vaccine in México until May 2021.
The overall impact of precautionary measures to mitigate the spread of COVID-19 on the health of PWH remains unknown. However, it will be important to establish public health interventions and policies that help reverse any damage that has been caused and to prevent similar situations in the future from profoundly affecting those most vulnerable and in need of continued medical care.
This is an opportunity for healthcare professionals to devise and implement creative strategies to continue delivering optimal medical care. To start, we should evaluate the main disruptions to the continuum of care, increase HIV testing, and enhance prevention efforts through more widespread implementation of PrEP programs.
Join the Discussion!
Now that we are a year into the pandemic, have you been able to implement strategies to mitigate the impact on your patients with HIV? If you missed the Webinars on this topic, you can watch my colleagues discuss these issues in these on-demand Webcasts.