Time Between Viral Loads for People With HIV During the COVID-19 Pandemic

  1. Walid G. El-Nahal
  2. Nicola M. Shen
  3. Jeanne C. Keruly
  4. Joyce L. Jones
  5. Anthony T. Fojo
  6. Yukari C. Manabe
  7. Richard D. Moore
  8. Kelly A. Gebo
  9. Geetanjali Chander
  10. Catherine R. Lesko

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Abstract

During the COVID-19 pandemic, patients experienced significant care disruptions, including laboratory monitoring. We investigated changes in the time between viral load (VL) checks for people with HIV (PWH) associated with the pandemic.

Setting and Methods:

This was an observational analysis of VLs of PWH in routine care at a large subspecialty clinic. At pandemic onset, the clinic temporarily closed its onsite laboratory. The exposure was time period (time varying): prepandemic (January 1, 2019–March 15, 2020); pandemic laboratory closed (March 16–July 12, 2020); and pandemic laboratory open (July 13–December 31, 2020). We estimated time from an index VL to a subsequent VL, stratified by whether the index VL was suppressed (≤200 copies/mL). We also calculated cumulative incidence of a nonsuppressed VL following a suppressed index VL, and of resuppression following a loss of viral suppression.

Results:

Compared with prepandemic, hazard ratios for next VL check were 0.34 (95% CI: 0.30 to 0.37, laboratory-closed) and 0.73 (CI: 0.68 to 0.78, laboratory-open) for suppressed patients, and 0.56 (CI: 0.42 to 0.79, laboratory-closed) and 0.92 (95% CI: 0.76 to 1.10, laboratory-open) for nonsuppressed patients. The 12-month cumulative incidence of loss of suppression was the same in the pandemic laboratory-open (4%) and prepandemic (4%) period. The hazard of resuppression following the loss of suppression was lower during the pandemic laboratory-open versus the prepandemic period (hazard ratio: 0.68, 95% CI: 0.50 to 0.92).

Conclusions:

Early pandemic restrictions and laboratory closure significantly delayed VL monitoring. Once the laboratory reopened, nonsuppressed patients resumed normal monitoring. Suppressed patients still had a delay but no significant loss of suppression.

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  1. Version published to 10.1097/qai.0000000000003026
  2. ScreenIT

    SciScore for 10.1101/2021.12.19.21268052: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: The Johns Hopkins HIV Clinical Cohort enrolls clinic patients who consent to share their medical record data.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Several limitations are worth noting in this analysis. Viral load monitoring requires the provider order a lab test and the patient get the lab test, and it is unclear from our findings alone whether delays in viral load monitoring were most influenced by less provider ordering or lower patient follow-through. In our analysis of loss of suppression and time to re-suppression, we are limited to viral loads that are observed. We may have underestimated the risk of both outcomes. Additionally, all viral load measurements apply only to a point in time, patients’ viral load between checks is unknown. Thus, we may have underestimated the probability of viral non-suppression due to loss of suppression (and subsequent re-suppression) that occurred during a prolonged, unmonitored period. Our analysis of time to initial suppression was limited by a very small sample size, reflected in wide confidence. Finally, the data were collected during the pandemic, limiting their generalizability and whether they should be used to inform monitoring frequency guidelines moving forward.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2021.12.19.21268052v1 on medRxiv