Efeitos da pandemia de COVID-19 no momento do diagnóstico e início do tratamento da infecção pelo HIV: análise em um centro de referência de Belo Horizonte.

Abstract

The COVID-19 pandemic created difficulties in access to screening and caused partial or total disruption of HIV and other chronic disease treatment services. HIV infection disproportionately affects vulnerable individuals, and COVID-19 had a unique impact on people living with HIV (PLHIV). In Brazil, there are few studies on the effect of the pandemic on the quality of care for these patients. This study evaluated the effects of the pandemic on the timing of diagnosis, treatment initiation, and HIV-related morbidities in patients treated at a referral center in Minas Gerais. Medical records of 275 patients with recent HIV infection diagnoses were retrospectively reviewed: 116 from the pre-pandemic period (PP, August to November 2019) and 159 from the pandemic period (DP, August to November 2021 and 2022), with stratified analysis between outpatient and hospitalized patients. The objective was to compare the frequency of late diagnosis (CD4+ T lymphocyte count <350 cells/mm³), advanced HIV disease (CD4+ T lymphocyte count <200 cells/mm³), HIV-related and non–HIV-related morbidities, and the time to initiation of antiretroviral therapy (ART). Associations with categorical variables were analyzed using the chi-square test, and differences in medians were assessed using Wilcoxon or Kruskal–Wallis tests. In outpatient care, the median log10 of the first viral load varied significantly: 4.36 (IQR 3.43–5.13) in PP, decreasing to 3.96 (3.71–4.52) in 2021 and 3.68 (3.17–4.27) in 2022 (p=0.004). The median first CD4+ count was 392 cells/mm³ (IQR 220–569) in PP, higher in DP: 516 cells/mm³ (402–634) in 2021 and 493 cells/mm³ (331–701) in 2022 (p=0.037). Late diagnosis occurred in 39% of patients in 2019, 18% in 2021, and 27% in 2022 (p=0.2). Advanced disease was observed in 20% in 2019, 12% in 2021, and 11% in 2022 (p=0.4). The most frequent non–HIV-related condition was syphilis, with a higher occurrence in 2021. There was a marked reduction in the median time from diagnosis to ART initiation: from 77 days in PP to 21 days in DP (p<0.001). The occurrence of immunodeficiency-related conditions also decreased: from 28.5% in PP to 5.9% in 2021 and 1.8% in 2022 (p<0.001). Among hospitalized patients, in the overall analysis, 85% had late diagnosis and 75% had advanced disease. Although slight reductions were noted—late diagnosis from 87% in PP to 84% in DP, and advanced disease from 75% in PP to 71% in DP—these changes were not statistically significant. During the pandemic, in outpatient settings, earlier diagnosis and a reduction in immunodeficiency-related conditions were observed, although there was an increase in HIV–syphilis coinfection. In the hospital setting, no significant differences were identified between PP and DP. Thus, up to November 2022, it was not possible to associate the pandemic with an increase in late HIV diagnoses in this service. On the contrary, improvements in care parameters were observed, with faster ART initiation and fewer immunodeficiency-related complications, particularly in outpatient care.