The impact of COVID-19 on HIV in Europe

Since the outbreak of the COVID-19 pandemic, HIV Outcomes has monitored the impact of this health crisis on people living with HIV, their health services and the civil organisations supporting them. Summarised below are the main findings from studies published during this period highlighting the broad impact of COVID on HIV communities.

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Impact of COVID-19 & HIV co-infection on mortality

People living with HIV have between a 78%-95% higher risk of death from COVID-19 than the general population and a 20% higher risk of hospitalization. The risk is higher for people who are not receiving antiretroviral therapy or have several HIV comorbidities.

Sabin, C., Raya, R., Curtis, H., Water, L., & Chadwick, D. (19–21 April 2021). BHIVA COVID Registry Working Group. Coronavirus (COVID)-19 in people with HIV in the UK: initial findings from the BHIVA COVID-19 Registry. Fifth Joint Conference of the British HIV Association and the British Association for Sexual Health and HIV.

Western Cape Department of Health in collaboration with the National Institute for Communicable Diseases, South Africa (2021). Risk Factors for Coronavirus Disease 2019 (COVID-19) Death in a Population Cohort Study from the Western Cape Province, South Africa. Clinical infectious diseases: an official publication of the Infectious Disases Society of America, 73(70), e2005-e2015. https://doi.org/10.1093/cid/ciaa1198

Williamson, E.J., Walker, A.J., Bhaskaran, K. et al. (2020). Factors associated with COVID-19-related death using OpenSAFELY. Nature, 584, 430–436. https://doi.org/10.1038/s41586-020-2521-4

Yendewa, G.A., Perez, J.A., Schlick, K.A., Tribout, H.A., & McComsey, G.A. (6–10 March 2021). Characterizing COVID-19 presentation and clinical outcomes in HIV patients in the US. Conference on Retroviruses and Opportunistic Infections.

Impact of COVID-19 on HIV stakeholders

In the WHO Europe region, up to 50% of HIV stakeholders stopped face-to-face HIV services since the beginning of the pandemic and almost 20% reported that users did not use their alternative service arrangements.

Aids Action Europe (2020). Impact of the COVID-19 pandemic survey. https://www.aidsactioneurope.org/en/publication/impact-covid-19-pandemic-report

Impact of COVID-19 on HIV care

Up to 70% of HIV clinics were disrupted in WHO Eastern Europe countries with 60% of physicians sharing HIV and COVID-19 care duties.

Kowalska, J. D., Skrzat-Klapaczyńska, A., Bursa, D., Balayan, T., Begovac, J., Chkhartishvili, N., Gokengin, D., Harxhi, A., Jilich, D., Jevtovic, D., Kase, K., Lakatos, B., Matulionyte, R., Mulabdic, V., Nagit, A., Papadopoulos, A., Stefanovic, M., Vassilenko, A., Vasylyev, M., Yancheva, N., … ECEE Network Group (2020). HIV care in times of the COVID-19 crisis – Where are we now in Central and Eastern Europe?. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, 96, 311–314. https://doi.org/10.1016/j.ijid.2020.05.013

Impact of COVID-19 on HIV consultations and enrolments

Case studies across WHO Europe show that HIV consultations fell by 50% and HIV enrolments by 20% at the outbreak of the pandemic (April 2020).

Rick, F., Odoke, W., van den Hombergh, J., Benzaken, A. S., & Avelino-Silva, V. I. (2021). Impact of coronavirus disease (COVID-19) on HIV testing and care provision across four continents. HIV medicine, 10.1111/hiv.13180. https://doi.org/10.1111/hiv.13180

Lourida, G., Leonidou, L., Psichogiou, M., T., C., Protopapas, K., Katsarolis, I., Xylomenos, G., Panagopoulos, P., Chini, M., & Papastamopoulos, V. (2020). Effect of first 3 months of COVID-19 pandemic on HIV services in Greece –a short survey among HIV physicians. HIV Glasgow. Retrieved January 17, 2022, from https://www.hivglasgow.org/wp-content/uploads/2020/11/P142_Lourida.pdf

Impact of COVID-19 vaccination on people living with HIV

People living with HIV were not prioritised for COVID-19 vaccination in around 60% of countries in WHO Europe and only 14% had national guidelines for the vaccination of people living with HIV.

Jilich D, Skrzat-Klapaczyńska A, Fleischhans L, Bursa D, Antoniak S, Balayan T, Begovac J, Cicic A, Dragovic G, Goekengin D, Harxhi A, Kase K, Lakatos B, Matulionyte R, Mulabdic V, Oprea C, Papadopoulos A, Rukhadze N, Tomazic J, Tovba L, Soj k Ľ, Vassilenko A, Yancheva N, Yurin O, Kowalska J; ECEE Network Group. National strategies for vaccination against COVID-19 in people living with HIV in Central and Eastern European region.HIV Med. 2021 Oct 26:10.1111/hiv.13194. https://doi.org/10.1111/hiv.13194

Impact of COVID-19 on HIV diagnosis

In WHO Europe, an estimated 25,143 individuals living with HIV were not diagnosed in 2020 because of the pandemic. This resulted in 104,765 new diagnoses in 2020 down from 136,449 in 2019 (a 26% decrease in HIV diagnoses).

European Centre for Disease Prevention and Control, WHO Regional Office for Europe (2021). HIV/AIDS surveillance in Europe 2021 – 2020 data. https://www.ecdc.europa.eu/sites/default/files/documents/2021-Annual_HIV_Report_0.pdf

Impact of COVID-19 on HIV testing

Due to the pandemic, an estimated 100,000 HIV tests were not performed in 2020 among the 8 EU/EEA countries that reported data on testing. * This resulted in 7,500,000 tests in 2020 down from 9,000,000 in 2019 (a 18% decrease in HIV tests). In the WHO Europe region, an estimated over 1,000,000 HIV tests were not performed last year, resulting in 57,000,000 tests in 2020 versus 70,000,000 in 2019 (a 18% decrease). This is because 60% of countries in WHO Europe reported a <50% decrease in HIV testing between March-May 2021.

*Belgium, Bulgaria, Czech Republic, Estonia, France, Latvia, Poland, Portugal, Romania, Slovenia

European Centre for Disease Prevention and Control, & WHO Regional Office for Europe (2021). HIV/AIDS surveillance in Europe 2021 – 2020 data. https://www.ecdc.europa.eu/sites/default/files/documents/2021-Annual_HIV_Report_0.pdf

Sim es, D., Stengaard, A. R., Combs, L., Raben, D., & EuroTEST COVID-19 impact assessment consortium of partners (2020). Impact of the COVID-19 pandemic on testing services for HIV, viral hepatitis and sexually transmitted infections in the WHO European Region, March to August 2020. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin, 25(47), 2001943. https://doi.org/10.2807/1560-7917.ES.2020.25.47.2001943

Hensley, K. S., Jordans, C. C. E., van Kampen, J. J. A., Mollema, F. P. N., Gisolf, E. H., el Moussaoui, R., Hermanides, G., van Beek, J. E. A., Vriesde, M. E., Finkenflügel, R. N. N., Rijnders, B. J. A., van de Vijver, D. A. M. C., Boucher, C. A. B., Verbon, A., & Rokx, C. (2021). Significant Impact of Coronavirus Disease 2019 (COVID-19) on Human Immunodeficiency Virus (HIV) Care in Hospitals Affecting the First Pillar of the HIV Care Continuum. Clinical Infectious Diseases, 1–4. https://doi.org/10.1093/cid/ciab445

Impact of COVID-19 on the mental health of people living with HIV

Case studies across WHO Europe show that around 40% of people living with HIV had mild to severe psychological distress since the COVID-19 outbreak and had a need for psychosocial support. Among this group, 70% reported feeling more depressed and anxious and 19% considering suicide.

Delle Donne, V., Ciccarelli, N., Massaroni, V., Lombardi, F., Lamonica, S., Borghetti, A., Fabbiani, M., Cauda, R., & Di Giambenedetto, S. (2021). Psychological distress during the initial stage of the COVID-19 pandemic in an Italian population living with HIV: an online survey. Le infezioni in medicina, 29(1), 54– 64. https://www.infezmed.it/media/journal/Vol_29_1_2021_6.pdf

Pantelic, M., Martin, K., Fitzpatrick, C., Nixon, E., Tweed, M., Spice, W., Jones, M., Darking, M., Whetham, J., & Vera, J. H. (2021). “I have the strength to get through this using my past experiences with HIV”: findings from a mixed-method survey of health outcomes, service accessibility, and psychosocial wellbeing among people living with HIV during the Covid-19 pandemic. AIDS care, 1–7. Advance online publication. https://doi.org/10.1080/09540121.2021.1975628

Impact of COVID-19 on HIV treatment

Case studies across WHO Europe show that 4% of people living with HIV (approximately 60,000) reported an interruption of ART due to lockdowns and that 6% (around 120,000) were unable to go collect ART due to mobility restrictions. Around 30% of people living with HIV in WHO Europe had to adapt their HIV care during the pandemic, facilitating an increase in the use of telehealth services. In addition, some EU countries experienced shortages in HIV medicines and the discontinuation of PrEP programmes. *

*Romania, Italy, Portugal, Ireland

Siewe Fodjo, J. N., Villela, E., Van Hees, S., Dos Santos, T. T., Vanholder, P., Reyntiens, P., Van den Bergh, R., & Colebunders, R. (2020). Impact of the COVID-19 Pandemic on the Medical Follow-up and Psychosocial Well- Being of People Living With HIV: A Cross-Sectional Survey. Journal of acquired immune deficiency syndromes , 85(3), 257–262. https://doi.org/10.1097/QAI.0000000000002468

Lakatos, B., Kowalska, J., Antoniak, S., Gokengin, D., Begovac, J., Vassilenko, A., Wasilewski, P., Fleischhans, L., Jilich, D., Matulionyte, R., Kase, K., Papadopoulus, A., Rukhadze, N., Harxhi, A., Hofman, S., Dragovic, G., Vasyliev, M., Verhaz, A., Yancheva, N., Oprea, C., … Euroguideliness in Central and Eastern Europe (ECEE) Network Group (2021). Retrospective evaluation of an observational cohort by the Central and Eastern Europe Network Group shows a high frequency of potential drug-drug interactions among HIV-positive patients receiving treatment for coronavirus disease 2019 (COVID-19). HIV medicine, 10.1111/hiv.13214. https://doi.org/10.1111/hiv.13214

European AIDS Treatment Group. (2020, May 26). EATG Rapid Assessment COVID-19 crisis’ Impact on PLHIV and on Communities Most Affected by HIV. AFEW International. Retrieved January 17, 2021, from https://afew.org/wp-content/uploads/2020/06/EATG-Rapid-Assessment-COVID19-2.pdf

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The impact of COVID-19 on HIV in Europe

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