Inside This Issue: 2020 HIV surveillance reports; rates of persistent COVID symptoms; Viral Hepatitis Federal Implementation Plan; NIAID antiviral drug development awards; anti-HIV antibody infusions show promise; and others.
HIV in the United States
2020 Surveillance Reports Document COVID-19 Pandemic’s Impact on HIV Diagnoses and Care
“The COVID-19 pandemic in the United States led to disruptions in HIV testing services and access to clinical services throughout 2020,” according to a recent Dear Colleagues letter by Dr. Demetre Daskalakis, director of the Center for Disease Control and Prevention’s (CDC’s) Division of HIV/AIDS Prevention. “This disruption resulted in a steep, single-year decline in HIV diagnoses that is mostly attributed to declines in testing caused by less frequent visits to health centers, reduced outreach services, and shifting of public health staff to COVID-19 response activities.”
Dr. Daskalakis’s letter summarizes these and other findings of two newly published CDC surveillance reports: Diagnoses of HIV Infection in the United States and Dependent Areas, 2020 and Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data-United States and 6 Dependent Areas, 2020. The overall number of HIV diagnoses in the U.S. during 2020 (30,403) was 17% lower than in 2019 (36,585). “Disruptions in clinical care services, patient hesitancy in accessing clinical services, shortages in HIV testing reagents and materials, shifting of partner services staff to COVID-19 activities, and disruptions in services provided by community-based organizations in 2020 likely led to underdiagnosis of HIV in the U.S.,” Dr. Daskalakis notes.
“Although state and local health departments quickly developed and implemented innovative strategies for HIV-related testing and care services, such as self-testing and telehealth, during the first year of the COVID-19 pandemic, these strategies did not make up for declines in laboratory-based HIV testing. In addition, telehealth visits might not have included orders for laboratory testing due to social distancing recommendations, or patients may have been reluctant to access testing during this time. Underreporting of laboratory test results to state and local HIV surveillance programs was not a major contributor to declines in diagnoses, as all jurisdictions reported entry and reported to CDC all laboratory results received.”
In 2020, the highest HIV diagnosis percentages and rates were seen among gay, bisexual, and other men who have sex with men; young adults between the ages of 25 and 34 years old; Black/African American persons; and persons living in the U.S. South. Close to half (47%) of HIV diagnoses in persons who inject drugs were among White persons and occurred in the South (44%).
Of the 46 U.S. jurisdictions with complete reporting of laboratory results, about four-fifths (82%) of people with HIV diagnosed during 2020 were linked to care within one month of diagnosis, and 65% had viral suppression. Data on pre-exposure prophylaxis (PrEP) use indicate that about 301,000 people were prescribed PrEP in 2020 – about 25% of those eligible for PrEP under current guidance.
Of the demographic groups studied, Black/African American persons and males who inject drugs had the lowest percentages (largest absolute disparities) in linkage to care (Black/African American persons: 80%; males who inject drugs: 78%) and viral suppression (Black/African American persons: 60%; males who inject drugs: 52%). Black/African American persons also had the lowest levels of PrEP coverage (9%).
“As we continue to navigate the COVID-19 pandemic, it is critical that we continue our work to expand and improve HIV prevention, care, and treatment for groups who could most benefit, including persons residing in the South; transgender persons; Black/African American women; and gay, bisexual, and other men who have sex with men,” Dr. Daskalakis writes. “We should continue our work to improve access to prevention services for persons who inject drugs, a population for whom progress continues to be threatened by the nation’s opioid and stimulant epidemics.”
Other New HIV Surveillance Resources: CDC has also produced a new slide set, HIV Infection, Stage 3 (AIDS) — 2020 (COVID-19 Pandemic), that summarizes parts of the 2020 HIV surveillance data. The 18 slides describe rates, percentages, and trends in the number (including cumulative data) of stage 3 classifications and persons living with diagnosed HIV infection ever classified as stage 3 in the United States and 6 dependent areas.
Another new report, HIV Surveillance Data Tables: Core Indicators for Monitoring the Ending the HIV Epidemic in the U.S. Initiative, NHSS Data through December 2021 and PrEP data through September 2021, includes the most recent available data for new HIV diagnoses, prompt linkage to care, viral suppression, and PrEP coverage, with breakdowns by gender, age, race/ethnicity, transmission category, and geographic region.
CDC Finds Substantial Rates of Persistent Symptoms Among COVID-19 Survivors
About one in five COVID-19 survivors between 18 and 64 years old, and about one in four survivors aged 65 years or older have experienced at least one health condition that might be attributable to COVID-19, according to a new report by researchers from CDC and GAP Solutions, Inc. For their study, the researchers analyzed electronic health record (EHR) data during the period March 2020 through November 2021 to assess the incidence of 26 conditions often attributable to post-COVID (“incident conditions”). They compared the rates of incident conditions among patients who had received a previous COVID-19 diagnosis (case-patients) to matched patients without evidence of COVID-19 in the EHR (control patients). The analysis divided patients into two age groups: 18 to 64 years old and 65 years or older.
Patients were followed between one month and one year after the index encounter until one or more incident conditions were observed or through October 31, 2021 – whichever occurred first. For the 18-to-64 year-old age group, 35.4% of case-patients experienced an incident condition compared with 14.6% of controls. Among those in the older age group, 45.4% of case-patients experienced an incident condition compared with 18.5% of controls. The incident conditions affected multiple body systems, and included cardiovascular, pulmonary, hematologic, renal, endocrine, gastrointestinal, musculoskeletal, neurologic, and psychiatric signs and symptoms.
“These findings translate to one in five COVID-19 survivors aged 18 to 64 years, and one in four survivors aged ≥65 years experiencing an incident condition that might be attributable to previous COVID-19,” the researchers noted. For both age groups, the rates of acute pulmonary embolism and respiratory signs and symptoms were more than twice as high among the case-patients as the control patients.
“As the cumulative number of persons ever having been infected with SARS-CoV-2 increases, the number of survivors suffering post-COVID conditions is also likely to increase,” according to the report. “Therefore, implementation of COVID-19 prevention strategies, as well as routine assessment for post-COVID conditions among persons who survive COVID-19, is critical to reducing the incidence and impact of post-COVID conditions, particularly among adults aged ≥65 years.”
HHS Publishes Viral Hepatitis Federal Implementation Plan
The U.S. Department of Health and Human Services (HHS) recently published the Viral Hepatitis Federal Implementation Plan (Implementation Plan), which summarizes the policies, research, and activities that federal partners intend to put into practice through 2025 to meet the goals of the Viral Hepatitis National Strategic Plan: A Roadmap to Elimination (2021-2025). The Viral Hepatitis Strategic Plan was released in early 2021 and provides a framework to eliminate viral hepatitis by 2030.
It includes the following five broad goals, together with a series of specific objectives and strategies for each goal:
- prevent new viral hepatitis infections;
- improve viral hepatitis-related health outcomes of people with viral hepatitis;
- reduce viral hepatitis-related disparities and health inequities;
- improve viral hepatitis surveillance and data usage; and
- achieve integrated, coordinated efforts that address the viral hepatitis epidemics among all partners and stakeholders.
The recently released Implementation Plan summarizes the policies, research, and activities that federal partners intend to put into practice through 2025 to meet the goals of the Viral Hepatitis Strategic Plan. The Implementation Plan was developed by a working group with representatives from 17 HHS agencies/offices and four additional federal departments.
“Carrying out the Viral Hepatitis Plan goes beyond what the federal government can do,” according to the HHS Office of Infectious Disease and HIV/AIDS Policy. “Its success depends on active participation by national, state, local, and tribal health departments and organizations, health plans and health care providers, community- and faith-based organizations, scientists, researchers, and the public working together with the federal government to achieve our collective goal to eliminate viral hepatitis in the United States.”
Innovative Antiviral Treatments
NIAID Announces $577 Million in Antiviral Drug Development Awards
The National Institute of Allergy and Infectious Diseases (NIAID) recently announced the award of about $577 million to establish nine Antiviral Drug Discovery (AViDD) Centers for Pathogens of Pandemic Concern. “The AViDD centers will conduct innovative, multidisciplinary research to develop candidate COVID-19 antivirals, especially those that can be taken in an outpatient setting, as well as antivirals targeting specific viral families with high potential to cause a pandemic in the future,” according to NIAID. These viral families include paramyxoviruses, bunyaviruses, togaviruses, filoviruses (including Ebola viruses and Marburg virus), picornaviruses (including enteroviruses and other cold-causing viruses), and flaviviruses (including the viruses that cause yellow fever, dengue, and Zika).
“The COVID-19 pandemic has highlighted the need for new antiviral drugs, especially those that could easily be taken by patients at home while their symptoms are still mild,” noted NIAID director Dr. Anthony Fauci. “Decades of prior research on the structure and vulnerabilities of coronaviruses greatly accelerated our response to the COVID-19 pandemic, and we hope that similar research focused on antivirals will better prepare us for the next pandemic.”
Anti-HIV Antibody Infusions Show Promise in Small Study
HIV researchers have proposed that the use of broadly neutralizing anti-HIV antibodies (bNAbs) might someday offer an alternative to daily antiretroviral therapy (ART) for people with HIV. Unfortunately, research involving the use of single bNAbs has shown only limited success in keeping virus levels low, in part, because bNAb-resistant HIV either already existed or emerged in persons receiving this experimental treatment. To address this problem, scientists in the NIAID Laboratory of Immunoregulation and five other research centers have tested a combination of two bNAbs – called 3BNC117 and 10-1074 – that target different parts of the surface of HIV.
The researchers conducted a two-part clinical trial between September 2018 and January 2021. The first part was a Phase 1 randomized, placebo-controlled trial that included 14 participants with HIV who had received ART soon after becoming infected with the virus. Under the trial protocol, these participants were taken off antiretrovirals shortly after receiving their first infusion of the combination bNAbs or placebo. They received up to eight bNAb or placebo infusions over a 24-week period. Their HIV viral load and CD4 T-cell counts were measured every two weeks.
In this part of the study, researchers hoped to learn whether combination bNAbs treatment could suppress HIV after participants stopped ART. They found that none of the seven participants who received the bNAb treatment had to restart ART in a 28-week period after their infusions, compared to six of the seven participants who received placebo infusions. The median amount of time that participants were off ART was 39.6 weeks for the bNAb group and 9.4 weeks for the placebo group, respectively.
The second part of the study involved giving combination bNAb infusions to a group of five participants with HIV who were not taking ART but still maintained low levels of the virus. The study researchers found that only two of the five participants maintained complete viral suppression for an average of 41.7 weeks following the bNAb transfusions. The researchers also learned that the bNAb combination was ineffective in suppressing HIV among participants with HIV that was resistant to either or both experimental antibodies before receiving the infusions.
The Global HIV/AIDS Epidemic
UNAIDS Highlights Efforts to Provide HIV Services to Persons Affected by War in Ukraine
On its website, UNAIDS has continued to publish articles about how the war in Ukraine has affected the provision of HIV services to Ukrainian citizens and refugees living with or at risk for HIV. Recent articles include the following:
- Kryvyi Rih AIDS centre continues to provide HIV services despite the war in Ukraine
- Helping Ukrainian refugees with HIV treatment and support in Berlin
- Addressing the vulnerabilities and challenges facing LGBTI people in and fleeing from Ukraine
- Keeping LGBTI people safe in times of war
- Grass-roots providers stay mobile in Ukraine
- Report highlights that women and marginalized people need urgent access to health-care services in Ukraine
- “A litmus test of civilization” – How the war in Ukraine has impacted LGBTI people
- Sustaining HIV services for people who use drugs in Odesa
- Welcoming Ukrainian refugees in Germany: Big test for all
- Life-saving logistics in Ukraine
- Urgently needed HIV services are supporting Ukrainian refugees in the Republic of Moldova
- Ukrainian activist Anastasiia Yeva Domani talks to UNAIDS about how the transgender community is coping during the war in Ukraine
- UNAIDS staff member talks about the invasion of Ukraine
Now Available: Videos and Slides from National Telehealth Conference
The National Telehealth Conference – hosted by HRSA’s Office of Telehealth and telehealth.hhs.gov – was held on May 16 and 17. The conference featured 12 sessions covering a wide range of topics including: HHS efforts to expand access to telehealth services; telehealth’s role in behavioral health services; telehealth and licensure portability; improving telehealth quality and breaking down barriers; ensuring access to telehealth beyond the COVID-19 pandemic; and the evolving world of telehealth technology. Videos of all 12 sessions and PDFs of slide sets for selected presentations are now available on the conference webpage.