Time Between Viral Loads for People With HIV During the COVID-19 Pandemic

Walid G. El-Nahal, Nicola M. Shen, Jeanne C. Keruly, Joyce L. Jones, Anthony T. Fojo, Yukari C. Manabe, Richard D. Moore, Kelly A. Gebo, Geetanjali Chander, Catherine R. Lesko

Research output: Contribution to journalArticlepeer-review

Abstract

Background:During the COVID-19 pandemic, patients experienced significant care disruptions, including laboratory monitoring. We investigated changes in the time between viral load (VL) checks for people with HIV (PWH) associated with the pandemic.Setting and Methods:This was an observational analysis of VLs of PWH in routine care at a large subspecialty clinic. At pandemic onset, the clinic temporarily closed its onsite laboratory. The exposure was time period (time varying): prepandemic (January 1, 2019-March 15, 2020); pandemic laboratory closed (March 16-July 12, 2020); and pandemic laboratory open (July 13-December 31, 2020). We estimated time from an index VL to a subsequent VL, stratified by whether the index VL was suppressed (≤200 copies/mL). We also calculated cumulative incidence of a nonsuppressed VL following a suppressed index VL, and of resuppression following a loss of viral suppression.Results:Compared with prepandemic, hazard ratios for next VL check were 0.34 (95% CI: 0.30 to 0.37, laboratory-closed) and 0.73 (CI: 0.68 to 0.78, laboratory-open) for suppressed patients, and 0.56 (CI: 0.42 to 0.79, laboratory-closed) and 0.92 (95% CI: 0.76 to 1.10, laboratory-open) for nonsuppressed patients. The 12-month cumulative incidence of loss of suppression was the same in the pandemic laboratory-open (4%) and prepandemic (4%) period. The hazard of resuppression following the loss of suppression was lower during the pandemic laboratory-open versus the prepandemic period (hazard ratio: 0.68, 95% CI: 0.50 to 0.92).Conclusions:Early pandemic restrictions and laboratory closure significantly delayed VL monitoring. Once the laboratory reopened, nonsuppressed patients resumed normal monitoring. Suppressed patients still had a delay but no significant loss of suppression.

Original languageEnglish (US)
Pages (from-to)109-116
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume91
Issue number1
DOIs
StatePublished - Sep 1 2022

Keywords

  • COVID-19 pandemic
  • continuum of care
  • human immunodeficiency virus
  • viral load

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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