Potential effects of #disruption to #HIV #programmes in sub-Saharan #Africa caused by #COVID19: results from multiple mathematical models (Lancet HIV, abstract)

[Source: Lancet HIV, full page: (LINK). Abstract, edited.]

Potential effects of disruption to HIV programmes in sub-Saharan Africa caused by COVID-19: results from multiple mathematical models

Britta L Jewell, PhD †, Edinah Mudimu, PhD †, John Stover, PhD †, Debra ten Brink, MD †, Prof Andrew N Phillips, PhD  †, Jennifer A Smith, DPhil, Rowan Martin-Hughes, PhD, Yu Teng, PhD, Robert Glaubius, PhD, Severin Guy Mahiane, PhD, Loveleen Bansi-Matharu, PhD, Isaac Taramusi, PhD, Newton Chagoma, PhD, Michelle Morrison, PhD, Meg Doherty, PhD, Kimberly Marsh, PhD, Anna Bershteyn, PhD, Prof Timothy B Hallett, PhD, Sherrie L Kelly, PhD, for the HIV Modelling Consortium

Open Access | Published: August 06, 2020 | DOI: https://doi.org/10.1016/S2352-3018(20)30211-3

 

Summary

Background

The COVID-19 pandemic could lead to disruptions to provision of HIV services for people living with HIV and those at risk of acquiring HIV in sub-Saharan Africa, where UNAIDS estimated that more than two-thirds of the approximately 38 million people living with HIV resided in 2018. We aimed to predict the potential effects of such disruptions on HIV-related deaths and new infections in sub-Saharan Africa.

Methods

In this modelling study, we used five well described models of HIV epidemics (Goals, Optima HIV, HIV Synthesis, an Imperial College London model, and Epidemiological MODeling software [EMOD]) to estimate the effect of various potential disruptions to HIV prevention, testing, and treatment services on HIV-related deaths and new infections in sub-Saharan Africa lasting 6 months over 1 year from April 1, 2020. We considered scenarios in which disruptions affected 20%, 50%, and 100% of the population.

Findings

A 6-month interruption of supply of antiretroviral therapy (ART) drugs across 50% of the population of people living with HIV who are on treatment would be expected to lead to a 1·63 times (median across models; range 1·39–1·87) increase in HIV-related deaths over a 1-year period compared with no disruption. In sub-Saharan Africa, this increase amounts to a median excess of HIV deaths, across all model estimates, of 296 000 (range 229 023–420 000) if such a high level of disruption occurred. Interruption of ART would increase mother-to-child transmission of HIV by approximately 1·6 times. Although an interruption in the supply of ART drugs would have the largest impact of any potential disruptions, effects of poorer clinical care due to overstretched health facilities, interruptions of supply of other drugs such as co-trimoxazole, and suspension of HIV testing would all have a substantial effect on population-level mortality (up to a 1·06 times increase in HIV-related deaths over a 1-year period due to disruptions affecting 50% of the population compared with no disruption). Interruption to condom supplies and peer education would make populations more susceptible to increases in HIV incidence, although physical distancing measures could lead to reductions in risky sexual behaviour (up to 1·19 times increase in new HIV infections over a 1-year period if 50% of people are affected).

Interpretation

During the COVID-19 pandemic, the primary priority for governments, donors, suppliers, and communities should focus on maintaining uninterrupted supply of ART drugs for people with HIV to avoid additional HIV-related deaths. The provision of other HIV prevention measures is also important to prevent any increase in HIV incidence.

Funding

Bill & Melinda Gates Foundation.

Keywords: SARS-CoV-2; COVID-19; HIV/AIDS; Africa.

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#COVID19 in Hospitalized Adults Living with #HIV (Open Forum Infect Dis,. abstract)

[Source: Open Forum Infectious Diseases, full page: (LINK). Abstract, edited.]

COVID-19 in Hospitalized Adults Living with HIV

Kate Stoeckle, MD, Carrie D Johnston, MD, Deanna P Jannat-Khah, DrPH, Samuel C Williams, BA, Tanya M Ellman, MD, Mary A Vogler, MD, Roy M Gulick, MD, Marshall J Glesby, MD, Justin J Choi, MD

Open Forum Infectious Diseases, ofaa327, https://doi.org/10.1093/ofid/ofaa327

Published: 01 August 2020

 

Abstract

Background

The spread of SARS-CoV-2 and the COVID-19 pandemic have caused significant morbidity and mortality worldwide. The clinical characteristics and outcomes of hospitalized patients with SARS-CoV-2 and HIV co-infection remain uncertain.

Methods

We conducted a matched retrospective cohort study of adults hospitalized with a COVID-19 illness in New York City between March 3, 2020 and May 15, 2020. We matched 30 people living with HIV (PLWH) with 90 control group patients without HIV based on age, sex, and race/ethnicity. Using electronic health record data, we compared demographic characteristics, clinical characteristics, and clinical outcomes between PLWH and control patients.

Results

In our study, the median age was 60.5 years (IQR 56.6–70.0), 20% were female, 27% were White, 30% were Black, and 24% were of Hispanic/Latino ethnicity. There were no significant differences between PLWH and control patients in presenting symptoms, duration of symptoms prior to hospitalization, laboratory markers, or radiographic findings on chest x-ray. More patients without HIV required a higher level of supplemental oxygen on presentation than PLWH. There were no differences in the need for invasive mechanical ventilation during hospitalization, length of stay, or in-hospital mortality.

Conclusions

The clinical manifestations and outcomes of COVID-19 among patients with SARS-CoV-2 and HIV co-infection were not significantly different than patients without HIV co-infection. However, PLWH were hospitalized with less severe hypoxemia, a finding that warrants further investigation.

coronavirus disease 2019, severe acute respiratory syndrome coronavirus 2, human immunodeficiency virus

Topic: hiv – adult – coinfection – sars-cov-2 – covid-19

Issue Section: Major Article

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© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Keywords: SARS-CoV-2; COVID-19; HIV/AIDS.

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#Variation in #mortality of #HIV / #SARS‐CoV‐2 co‐infected patients in the #Bronx, #NYC (J Med Virol., abstract)

[Source: Journal of Medical Virology, full page: (LINK). Abstract, edited.]

Variation in mortality of HIV/SARS‐CoV‐2 co‐infected patients in the Bronx, New York City

Kulachanya Suwanwongse MD, MSc,  Nehad Shabarek MD

First published: 29 July 2020 | DOI:  https://doi.org/10.1002/jmv.26370

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/jmv.26370

 

Abstract

Coronavirus disease 2019 (COVID‐19) pandemic has caused tremendous strain on global health care systems and impacted the human quality of life worldwide. HIV patients are vulnerable to certain fatal infection due to their deficient immune functions. Nonetheless, the immunocompromised state may prevent HIV patients from severe hyper‐immunity respond to COVID‐19. To date, the impact of HIV on the clinical courses and outcomes of COVID‐19 is inconclusive, and study answering this matter is evolving. We recently published the case series of nine HIV/SARS‐CoV‐2 co‐infected patients admitted to our hospital during the early‐wave of the pandemic in New York City, which contained the worrying mortality at 78%. Herein, we presented the clinical features and outcomes of another five confirmed COVID‐19 patients with HIV infection who admitted to our hospital during the resolving pandemic phase of NYC, which showed an improved mortality rate at 20%. Notwithstanding, 60% of patients still had severe COVID‐19 complicated with acute respiratory distress syndrome (ARDS) and shock. The extremely high mortality rate in our case series may be due to the mortality biases, the delay in corticosteroids administration, different vulnerability of patients, and the limitation of healthcare resources.

This article is protected by copyright. All rights reserved.

Keywords: SARS-CoV-2; COVID-19; HIV/AIDS; USA; NYC.

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#HIV and #SARS-CoV-2: Intersecting #Epidemics with Many #Unknowns (Am J Epidemiol., abstract)

[Source: American Journal of Epidemiology, full page: (LINK). Abstract, edited.]

HIV and SARS-CoV-2: Intersecting Epidemics with Many Unknowns

Catherine R Lesko, Angela M Bengtson

American Journal of Epidemiology, kwaa158, https://doi.org/10.1093/aje/kwaa158

Published: 22 July 2020

 

Abstract

As of July 2020, approximately 6 months into the pandemic of novel coronavirus disease 2019 (COVID-19), whether people living with HIV (PLWH) are disproportionately affected remains an unanswered question. Thus far, risk of COVID-19 in people with and without HIV appears similar but data are sometimes contradictory. Some uncertainty is due to the recency of the emergence of COVID-19 and sparsity of data; some is due to imprecision about what it means for HIV to be a “risk factor” for COVID-19. Forthcoming studies on the risk of COVID-19 to PLWH should differentiate between 1) the unadjusted, excess burden of disease among PLWH to inform surveillance efforts; and 2) any excess risk of COVID-19 among PLWH due to biological effects of HIV, independent of comorbidities that confound rather than mediate this effect. PLWH bear a disproportionate burden of alcohol, other drug use, mental health disorders, and other structural vulnerabilities, which may increase their risk of COVID-19. In addition to any direct effects of COVID-19 on the health of PLWH, we need to understand how physical distancing restrictions impact secondary health outcomes, and the need for, accessibility of, and impact of alternative modalities of providing ongoing medical, mental health, and substance use treatment that comply with physical distancing restrictions (e.g., telemedicine).

COVID-19, Engagement in care, HIV, Mental health, Substance use, Telemedicine

Issue Section: Data-Driven Commentary

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© The Author(s) 2020. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: SARS-CoV-2; COVID-19; HIV/AIDS; Society.

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Potential #impact of the #COVID19 pandemic on #HIV, #tuberculosis, and #malaria in low-income and middle-income countries: a modelling study (Lancet Glob Health, abstract)

[Source: Lancet Global Health, full page: (LINK). Abstract, edited.]

Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study

Alexandra B Hogan, PhD †, Britta L Jewell, PhD †, Ellie Sherrard-Smith, PhD †, Juan F Vesga, PhD †, Oliver J Watson, PhD †, Charles Whittaker, MSc †, Arran Hamlet, PhD, Jennifer A Smith, DPhil, Peter Winskill, PhD, Robert Verity, PhD, Marc Baguelin, PhD, John A Lees, PhD, Lilith K Whittles, PhD, Kylie E C Ainslie, PhD, Samir Bhatt, DPhil, Adhiratha Boonyasiri, MD, Nicholas F Brazeau, PhD, Lorenzo Cattarino, PhD, Laura V Cooper, MPhil, Helen Coupland, MRes, Gina Cuomo-Dannenburg, MMath, Amy Dighe, MRes, Bimandra A Djaafara, MRes, Prof Christl A Donnelly, ScD, Jeff W Eaton, PhD, Sabine L van Elsland, PhD, Richard G FitzJohn, PhD, Han Fu, PhD, Katy A M Gaythorpe, PhD, William Green, MRes, David J Haw, PhD, Sarah Hayes, MSc, Wes Hinsley, PhD, Natsuko Imai, PhD, Daniel J Laydon, PhD, Tara D Mangal, PhD, Thomas A Mellan, PhD, Swapnil Mishra, PhD, Gemma Nedjati-Gilani, PhD, Kris V Parag, PhD, Hayley A Thompson, MPH, H Juliette T Unwin, PhD, Michaela A C Vollmer, PhD, Caroline E Walters, PhD, Haowei Wang, MSc, Yuanrong Wang, Xiaoyue Xi, MSc, Prof Neil M Ferguson, DPhil, Lucy C Okell, PhD, Thomas S Churcher, PhD, Nimalan Arinaminpathy, DPhil, Prof Azra C Ghani, PhD, Patrick G T Walker, PhD, Prof Timothy B Hallett, PhD

Open Access | Published: July 13, 2020 | DOI: https://doi.org/10.1016/S2214-109X(20)30288-6

 

Summary

Background

COVID-19 has the potential to cause substantial disruptions to health services, due to cases overburdening the health system or response measures limiting usual programmatic activities. We aimed to quantify the extent to which disruptions to services for HIV, tuberculosis, and malaria in low-income and middle-income countries with high burdens of these diseases could lead to additional loss of life over the next 5 years.

Methods

Assuming a basic reproduction number of 3·0, we constructed four scenarios for possible responses to the COVID-19 pandemic: no action, mitigation for 6 months, suppression for 2 months, or suppression for 1 year. We used established transmission models of HIV, tuberculosis, and malaria to estimate the additional impact on health that could be caused in selected settings, either due to COVID-19 interventions limiting activities, or due to the high demand on the health system due to the COVID-19 pandemic.

Findings

In high-burden settings, deaths due to HIV, tuberculosis, and malaria over 5 years could increase by up to 10%, 20%, and 36%, respectively, compared with if there was no COVID-19 pandemic. The greatest impact on HIV was estimated to be from interruption to antiretroviral therapy, which could occur during a period of high health system demand. For tuberculosis, the greatest impact would be from reductions in timely diagnosis and treatment of new cases, which could result from any prolonged period of COVID-19 suppression interventions. The greatest impact on malaria burden could be as a result of interruption of planned net campaigns. These disruptions could lead to a loss of life-years over 5 years that is of the same order of magnitude as the direct impact from COVID-19 in places with a high burden of malaria and large HIV and tuberculosis epidemics.

Interpretation

Maintaining the most critical prevention activities and health-care services for HIV, tuberculosis, and malaria could substantially reduce the overall impact of the COVID-19 pandemic.

Funding

Bill & Melinda Gates Foundation, Wellcome Trust, UK Department for International Development, and Medical Research Council.

Keywords: SARS-CoV-2; COVID-19; HIV/AIDS; Tuberculosis; Malaria.

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#HIV and #SARS CoV‐2 #coinfection: A retrospective, record based, case series from South #India (J Med Virol., abstract)

[Source: Journal of Medical Virology, full page: (LINK). Abstract, edited.]

HIV and SARS CoV‐2 co‐infection: A retrospective, record based, case series from South India

Dr Janakiram Marimuthu,  Dr Bubby S Kumar,  Dr P Aravind Gandhi

First published: 07 July 2020 | DOI:  https://doi.org/10.1002/jmv.26271

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/jmv.26271

 

Abstract

HIV prevalence in India is about 0.22%, with the total number of people living with HIV/AIDS (PLHA) is estimated at 21.40 lakhs, constituting third largest epidemic in world. However, no study on HIV‐COVID‐19 co‐infection has been reported from India. We conducted a retrospective, record based case series including three males, 2 females and 1 transgender PLHA co‐infected with SARS CoV‐2 in the Indian state of Tamil Nadu. Fever (5), followed by cough (2) and sore throat (1), were the presenting symptoms. Latest Median CD4 count among our patients was 535 cells/ mm3. One of the patients was not under clinical HIV control, with an opportunistic infection Two among our patients were having hypertension. The mainstay of treatment given for the patients consisted of multi‐vitamins in addition to the ARV drugs, anti‐pyretics and anti‐tussives. One of the patient was on low dose Ritonavir boosted HAART regimen. All patients had stable vitals at room conditions, did not have any complications during their entire stay in health care facility for COVID‐19, treated and discharged.

This article is protected by copyright. All rights reserved.

Keywords: SARS-CoV-2; COVID-19; HIV/AIDS; India.

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#Plasma-based #COVID19 #treatments in low- and middle-income nations pose a high risk of an #HIV #epidemic (npj Vaccines, summary)

[Source: npj Vaccines, full page: (LINK). Abstract, edited.]

Plasma-based COVID-19 treatments in low- and middle-income nations pose a high risk of an HIV epidemic

Leonardo M. R. Ferreira & Mohammed A. Mostajo-Radji

npj Vaccines volume 5, Article number: 58 (2020)

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Convalescent plasma therapy holds promise as a transient treatment for COVID-19. Yet, blood products are important sources of HIV infection in low- and middle-income nations. Great care must be taken to prevent plasma therapy from fueling HIV epidemics in the developing world.

(…)

Keywords: SARS-CoV-2; COVID-19; Serotherapy; HIV/AIDS.

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When #COVID19 Crosses Paths with #AIDS in the #Homeless (J Med Virol., abstract)

[Source: Journal of Medical Virology, full page: (LINK). Abstract, edited.]

When COVID‐19 Crosses Paths with AIDS in the Homeless

Paulina Przydzial MD,  Ghislain Tchomobe MD,  Krushna Amin MD,  Engell Christian MD, Alexis K Okoh MD

First published: 03 July 2020 | DOI:  https://doi.org/10.1002/jmv.26255

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/jmv.26255

 

ABSTRACT

The coronavirus disease of 2019 (COVID‐19) pandemic has created new challenges and magnified existing ones for immunocompromised individuals who may be at risk for worse clinical outcomes. Severe COVID‐19 has been associated with a hyperimmune response characterized by a surge in cytokine release defined as a cytokine release syndrome (CRS) (1). Among immunocompromised patients, the inability to mount an immune response may be protective against a poor outcome.

This article is protected by copyright. All rights reserved.

Keywords: SARS-CoV-2; COVID-19; Society; HIV/AIDS.

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Four #Decades of #HIV/AIDS — Much Accomplished, Much to Do (N Engl J Med., summary)

[Source: The New England Journal of Medicine, full page: (LINK). Summary, edited.]

Four Decades of HIV/AIDS — Much Accomplished, Much to Do

Anthony S. Fauci, M.D., and H. Clifford Lane, M.D.

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The dramatic saga of the acquired immunodeficiency syndrome (AIDS) features an early sense of helplessness and frustration in the face of a mysterious new disease, courage on the part of the afflicted, and the gradual accrual of groundbreaking scientific advances that have brought hope to a formerly desperate situation. This progress began with a series of detailed epidemiologic studies, which were followed by the discovery of the human immunodeficiency virus (HIV) as the causative agent of AIDS, and has culminated in highly effective treatment regimens that have transformed HIV from a near-certain death sentence to a manageable disease (see timeline). Looking ahead, and considering the spectacular scientific advances that have been made over nearly four decades, it is conceivable that with optimal implementation of available prevention strategies and treatments, the end of HIV/AIDS as a global pandemic will be attainable.

(…)

Keywords: HIV/AIDS.

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#Pneumocystis Jirovecii #Pneumonia and #SARS-CoV-2 Co-Infection in newly diagnosed #HIV-1 infection (Clin Infect Dis., summary)

[Source: Clinical Infectious Diseases, full page: (LINK). Summary, edited.]

Pneumocystis Jirovecii Pneumonia and SARS-CoV-2 Co-Infection in newly diagnosed HIV-1 infection

Sebastian Mang1, Dominic Kaddu-Mulindwa2, Carlos Metz1, André Becker1, Frederik Seiler1, Sigrun Smola3, Alexander Maßmann4, Sören L. Becker5, Cihan Papan5, Robert  Bals1, Philipp M. Lepper1, Guy Danziger1

1  Department of Pneumology, Allergology and Critical Care Medicine, Saarland  University, Homburg/Saar, Germany; 2 Department of Hematology, Oncology, Clinical  Immunology, Rheumatology, Saarland University, Homburg/Saar, Germany; 3 Center for  Infectious Diseases, Institute of Virology, Saarland University, Homburg/Saar, Germany; 4  Clinic for Diagnostic and Interventional Radiology, Saarland University Medical  Center, Homburg/Saar, Germany; 5 Center for Infectious Diseases, Institute of Medical  Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany

Correspondence to: Sebastian Mang, MD, Department of Internal Medicine V –  Pneumology, Allergology and Intensive Care Medicine  and ECLS Center Saar, Universityhospital of Saarland, Kirrberger Str. 100, 66421 Homburg, Germany, Phone: +49-6841 16 15000, Fax: +49-6841 16 15208, Email: sebastian.mang@uks.eu

Downloaded from https://academic.oup.com/cid/article-abstract/doi/10.1093/cid/ciaa906/5865456 by guest on 01 July 2020

Accepted Manuscript

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DEAR EDITOR – It was recently suggested that excess risk of respiratory failure due to COVID-19 may be lower than expected for people living with human immunodeficiency  virus (PLWH) [1]. We report the case of a 52-year-old male from our intensive care unit  (ICU) who developed acute respiratory failure due to Covid-19, Pneumocystis jirovecii  Pneumonia (PJP) and newly diagnosed HIV, stage 3 [2]. Diagnosis of SARS-CoV-2 disguised  the presence of PJP.

(…)

Keywords: SARS-CoV-2; COVID-19; Pneumcystosis; HIV/AIDS.

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