Department of Infectious Diseases and Clinical Microbiology, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa University Medical Faculty, Istanbul, Turkey.
Curr HIV Res. 2022;20(3):236-241. doi: 10.2174/1570162X20666220303103805.
The COVID-19 pandemic has substantially changed lives and presented several barriers to health services. HIV care continuum needs a high rate of diagnosis, effective treatment, and sustained suppression of viral replication. The COVID-19 pandemic has affected these three steps of HIV care. This study investigated the characteristics of newly diagnosed patients living with HIV/AIDS (PLWH) during the COVID pandemic and compared them with those before the pandemic.
All newly diagnosed patients in three HIV healthcare centers, in Istanbul, Turkey, were included in the study. The pandemic period included April 1, 2020, to April 1, 2021, and the prepandemic period included March 1, 2019, to March 1, 2020.
756 patients were diagnosed with HIV/AIDS. In the pandemic period, this figure was 58% less: 315. Patients in the pre-pandemic and pandemic period had comparable age and gender distributions. PLWH diagnosed in the pandemic period had higher rates of low CD4 cells: low CD4 (<350 cells /mm3) was measured in 243 (36.4%) patients in the pre-pandemic period, while it was done in 126 (47.9%) in the pandemic period (p<0.01). Also, the distribution of CD4 cells was significantly different between periods: In the pandemic period, CD4 cell distribution significantly skewed to lower CD4 categories. Symptomatic patient rates and AIDS-defining disorder rates among symptomatic patients were comparable. Viral loads were not significantly different in the two periods.
A low number of newly diagnosed PLWH can be explained by less HIV testing, less admission to health care, or an actual decrease of HIV prevalence during the pandemic. Sexual behaviors may have changed during the COVID-19 pandemic, leading to HIV transmission restriction. Lower CD4 counts among the newly diagnosed PLWH suggest that admittance to health care is late and a significant portion of PLWH remain undiagnosed.
COVID-19 大流行极大地改变了人们的生活，并对卫生服务造成了多种障碍。艾滋病毒护理连续体需要高比例的诊断、有效治疗和持续抑制病毒复制。COVID-19 大流行影响了艾滋病毒护理的这三个步骤。本研究调查了 COVID 大流行期间新诊断为艾滋病毒/艾滋病（PLWH）患者的特征，并将其与大流行前进行了比较。
本研究纳入了土耳其伊斯坦布尔的三个艾滋病毒医疗中心的所有新诊断为 HIV/AIDS 的患者。大流行期间为 2020 年 4 月 1 日至 2021 年 4 月 1 日，大流行前期间为 2019 年 3 月 1 日至 2020 年 3 月 1 日。
共有 756 名患者被诊断为 HIV/AIDS。在大流行期间，这一数字减少了 58%：315 名患者。大流行前和大流行期间的患者年龄和性别分布相似。在大流行期间诊断出的 PLWH 中，低 CD4 细胞的比例更高：在大流行前期间，有 243 名（36.4%）患者的低 CD4（<350 个细胞/mm3），而在大流行期间则有 126 名（47.9%）患者的低 CD4（p<0.01）。此外，两个时期的 CD4 细胞分布明显不同：在大流行期间，CD4 细胞分布明显向较低的 CD4 类别倾斜。有症状患者的比例和有症状患者的艾滋病定义性疾病的比例相似。两个时期的病毒载量没有显著差异。
新诊断的 PLWH 数量较少，可以解释为 HIV 检测次数减少、到卫生保健机构就诊减少，或者大流行期间 HIV 流行率实际下降。COVID-19 大流行期间，性行为可能发生了变化，导致 HIV 传播受限。新诊断的 PLWH 中较低的 CD4 计数表明，他们到卫生保健机构就诊较晚，并且很大一部分 PLWH 仍未被诊断出来。
