Acute HIV Cases Have Doubled During COVID-19

Patients newly infected with HIV are being diagnosed in greater numbers because they are showing up at hospitals with symptoms similar to COVID-19, researchers reported at the 2020 virtual IDWeek conference.

In this exclusive MedPage Today video, Matthew Spinelli, MD, of the University of California San Francisco, offers an explanation and discusses the clinical implications.

Following is a transcript of his remarks:

The authors of this study were taking advantage of a preexisting program to screen for acute HIV for anyone presenting with influenza-like illness to their ER. They also had a routine screening program outside of that. That program targeted towards diagnosing acute HIV. And what they found, interestingly, is that they are seeing about twice the rate of acute HIV diagnoses since the COVID-19 pandemic.

They're reporting that they saw 2.14-fold the incidence rate ratio, which was statistically significant. And they report good outcomes, linking people to care and starting them on antiretrovirals.

But I think the important point here is we're seeing a bunch of difficult impacts on the HIV epidemic. The role of HIV and how people respond to COVID-19 seems to suggest that it does not have a big impact outside of other co-morbidities. But in the converse direction, COVID-19 is leading to decreased HIV testing, decreased refills for PrEP [pre-exposure prophylaxis] and worse HIV outcomes. And now this is a study showing increased acute HIV diagnoses.

So, I think there could be a variety of explanations. I think most likely is the increased socioeconomic stress on populations, on vulnerable populations, people losing jobs, the increase in substance use, and mental health issues that have been reported by a variety of other authors, are leading to increased risk of HIV infection. And I'm worried that this could be an omen of what we could see in the next year, in terms of the HIV epidemic.

So I think the clinical implications of this is that we need to continue to screen for HIV, keep that in our differential, when people present with influenza-like illness or when we're concerned for COVID-19 and make sure we're doing everything we can to ensure HIV prevention, and [that] HIV treatment services are remaining in place in at least some form for people during this unprecedented time.

Comment