Challenges in HIV care at a tertiary hospital repurposed for COVID-19: an observational study (2019-2022).

backgroundThe COVID-19 pandemic disrupted global healthcare systems, reducing access to care for people with chronic conditions, including HIV. In Mexico, the National Institute of Respiratory Diseases (INER) was fully repurposed as a COVID-19 referral center, interrupting routine HIV services. CIENI, an HIV clinic within INER, implemented mitigation strategies to preserve care for people living with HIV (PLWH). Concurrently, national guidelines introduced BIC/FTC/TAF as the new first-line antiretroviral regimen in 2019. We aimed to assess the impact of INER’s reconversion on clinical outcomes of PLWH, within the context of newly adopted treatment guidelines.

methodsWe conducted a retrospective, repeated cross-sectional study at an specialized HIV clinic located inside the largest referral center for complicated COVID-19 nationally. Three periods were defined: pre-pandemic (Jan 2019–Feb 2020), pandemic (Mar 2020–Dec 2021), and post-pandemic (Jan–Dec 2022). Outcomes included HIV-related clinical markers (viral load, CD4), follow-up indicators (adherence, antiretroviral [ART] delivery, treatment abandonment, hospitalization, referrals, death), chronic comorbidities (hypertension, obesity, dyslipidemia, diabetes, cancer), and common infections (syphilis, HBV, HCV, TB). Statistical comparisons between pre- and post-pandemic periods included bivariate analyses, linear regression model on hospitalization rates change, and logistic regression for weight gain after ART regimen change. All analyses were conducted in R.

resultsAmong 700 PLWH (85.7% men), 79.2% continued care at our center, 13.9% were referred elsewhere, 6.9% were lost to follow-up and 2% died. During repurposing, HIV testing, ART initiation, on-site consultations, and non-COVID-19 hospitalizations were suspended. The proportion with CD4 < 200 cells/µL decreased from 10.8% to 6.1% (p = 0.004), while undetectable viral load frequencies remained stable (90.4% vs. 90.7%, p = 0.421). Dyslipidemia increased from 65.3% to 77.8% (p < 0.001), and obesity from 11.3% to 20.2% (p < 0.001). No significant association was observed between BIC/FTC/TAF use and BMI change in the post-pandemic period. Frequencies of cancer, tuberculosis, HBV, and HCV declined, likely due to limited screening (all p < 0.014). Mitigation strategies included multi-month ART dispensation, hospitalization agreements, and telemedicine.

conclusionsLocally-implemented strategies and ART switch sustained HIV control and reduced mortality, but comorbidities were insufficiently addressed. Timely access to HIV care should be prioritized in future crises.