There is a significant increase in the number of patients with acute HIV infections. These patients sought treatment in the emergency department in Chicago during the COVID-19 pandemic. This was declared in a study presented by a new research from a team in Chicago in the 2020 virtual IDWeek conference. Here, Timothy P. Lahey, MD, of the University of Vermont Medical Center, discusses the main take-home messages regarding HIV screening.
Analysis Of This HIV Study In A Gist
Acute HIV infection is underdiagnosed chronically. This leads to late engagement and care and missed opportunities for prevention. Enhanced acute HIV infection screening can identify otherwise missed high risk individuals. This has been shown in inpatients in high-prevalence areas as well as STI clinics and other settings. And of course, the COVID-19 pandemic intensifies the threat to misdiagnoses of acute HIV infection through lower engagement to care, among other problems.
This is a problem that’s going to preferentially affect our most vulnerable populations who could be adversely affected by both COVID-19 and the risk of undiagnosed HIV. So the authors did an excellent study building on work they’d already done in a collaboration of a consortium of 15 different screening sites in various neighborhoods in Chicago called the Expanded HIV Testing and Linkage to Care Program or xTLC. They used a pre-existing workflow through collaborating emergency rooms to identify people at high risk of having acute HIV infection. They then followed how that program was going early in the COVID-19 pandemic.
Connections Were Re-Intensified
Defining acute HIV as a positive HIV immunoassay with a negative supplemental antibody test and a positive confirmatory PCR viral load. What they showed was a massive surge at their hospital, as all hospitals experienced, in diagnostic screening for infectious diseases of various types with a COVID-19 surge, dwarfing screening for all other diagnostic infections. But of course, there were a number of respiratory infections like influenza, RSV, that were checked for early on in 2020, dropping off as the spring progressed.
They saw a decrease in 22,502 tests in January/February, and nearly 12,000 tests in May. This constituted a reduction in HIV screens of about 58%. They also saw that they were able with re-intensified connections to the emergency departments, to enhance acute HIV infection screening in patients who are suspected of having COVID-19 once they sort of had people know the overlap in symptoms and therefore the need to do some testing.
Screens Are Just For Acute HIV Infection
Ultimately, they were able to boost up testing rates to 19,111 tests between January and August of 2020. They were able to diagnose 19 otherwise missed cases of the infection through that screening effort. And when they compare the number of acute HIV infection cases that were identified thus far in 2020 and those eight months, it actually equaled the total number of acute HIV cases that had been identified in 2019, and was more than double those identified in 2018.
A surge in acute HIV infection diagnoses was seen. They found three additional cases and they say that this is an increase in the total incidents. Whether this is generalizable to populations where the likelihood of the infection is lower, or programs that have a less mature language to their screening and emergency rooms, is yet to be seen.
What’s The Take-Home Message?
But the take-home messages are that while acute HIV infection screening probably is threatened by the COVID-19 pandemic disruptions to healthcare in general, but re-intensified screening efforts can help. And that there is a chance that we can actually identify more infections either because we’re intensifying our diagnostic workup, or there’s more public concern and people are coming forward with overlapping symptoms, or perhaps because risk behaviors have changed.