Patients newly infected with HIV are being diagnosed in greater numbers because they are showing up at hospitals with symptoms similar to infection with SARS-CoV-2, researchers reported at the 2020 virtual IDWeek conference.
While routine screening in the emergency room often finds undiagnosed cases of HIV, acute infections – when viral loads are high and transmission is heightened among these newly-infected individuals – occur less often, said David Pitrak, MD, of the University of Chicago.
But during the first 8 months of the COVID-19 pandemic, his institution found new cases of acute HIV infection at an annualized rate of 14.4 per year, Pitrak said in his oral presentation. In contrast, the annual rate during the previous 4 years was 6.8 (incidence ratio 2.14, 95% CI 1.01-4.54).
Pitrak said the first case of COVID-19 was diagnosed on Jan. 24, and from that point until August 17, nine acute HIV infections were diagnosed (along with 26 other non-acute cases). All the acute HIV cases were diagnosed in the emergency department, as were most of the others.
Pitrak said all the newly diagnosed acute cases entered treatment.
Robert Glatter, MD, of Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York City, commented, “We advocate screening for any patient who requests to be tested, regardless of exposure history or risk factors. It’s a practical public health approach that encourages patients to know their status.”
“Since the pandemic began, I have not been seeing a significant increase in the number of patients who test positive for HIV,” he told MedPage Today. “That said, I have taken care of a few patients in the emergency room with newly diagnosed COVID-19 who incidentally tested positive for HIV. An HIV test is part of the diagnostic and lab evaluation when we evaluate patients at high risk for COVID-19, or who are found to be positive for COVID-19. It is vital to know their HIV status in the setting of such a viral illness.”
Glatter noted that “one of the most common first symptoms in a patient with acute HIV infection is fever. This may also be accompanied by fatigue, muscle aches, chills, and a sore throat.”
“While some patients with COVID-19 may also present with fever or in a similar fashion, up to 40% of patients with COVID-19 may also be asymptomatic. Some patients with COVID-19 may only have loss of taste or smell or have minor fatigue, chest pain, headache, a dry cough, or a low grade fever.”
“The spectrum of COVID-19 presentation can also include neurological symptoms including dizziness, numbness, or tingling — as well as stroke or stroke-like symptoms,” Glatter said.
Pitrak suggested that the upsurge in acute HIV cases discovered in his hospital might be due to several reasons:
- Patients experiencing acute HIV infection symptoms may seek emergency medical treatment because of concern over possible COVID-19 infection.
- Acute HIV infections could occur from changes in behavior precipitated by the pandemic.
- Acute infection could also stem from disruptions in the continuum of care for people living with HIV and their partners, or a disruption in care among at-risk people who are using pre-exposure prophylaxis to prevent infection.
The increase in acute HIV infection diagnoses at Pitrak’s institution came even as overall screening for HIV at a consortium of 15 healthcare sites in south and west Chicago was reduced during the pandemic, he said. In the period from January to February of this year, the clinics performed 22,502 tests, but in April and May when COVID-19 cases were increasing, HIV testing at these clinics fell to 11,766. And even in June, the testing for HIV at the clinics was down by 32%.
Pitrak suggested that the reason more acute HIV infections were captured than usual might be due to the nature of early HIV infection. “The symptoms of COVID-19 infection [overlap with] infection with other respiratory viruses and acute HIV infection,” he said, “Screening patients with an influenza-like illness for HIV is an opportunity to identify patients with acute HIV infection, a priority population for public health.”
Median age for the acute cases was 25 (range 21-28), and seven of the nine were men. Median viral load was 6 million copies/mL. Eight of the nine presented with symptoms that were indistinguishable from COVID-19, and one of the patients was co-infected with both HIV and SARS-CoV-2.
“All nine patients were notified of their status, linked to care, and were initiated on antiretroviral therapy,” Pitrak said. Because the pandemic had put high demand on laboratory personnel and made testing reagents scarce, it took a median of 3 days to confirm the HIV testing results, he said.
Pitrak said three more cases of acute HIV infection have been diagnosed among two heterosexual men and one heterosexual woman after the study was prepared for presentation.
IDWeek is jointly sponsored by the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists.
Pitrak disclosed relevant relationships with Gilead Sciences. Glatter disclosed no relevant relationships with industry.