The Burden of COVID-19 in People Living with HIV: A Syndemic Perspective

In March 2020, the Centers for Disease Control and Prevention (CDC) highlighted people living with HIV (PLWH) as a population that may be at heightened risk for severe physical health illness from the new coronavirus disease known as COVID-19 compared to the general population. To understand the manifestation of COVID-19 in the lives of PLWH, it must be viewed alongside HIV and other health conditions that already exist in this population. Effective antiretroviral therapy (ART) has prolonged the lifespan of PLWH. In the United States, 1.2 million people are living with HIV. Of these, more than 50% are 50 + years of age, and many physical complications related to long-term ART use and aging have arisen. Older PLWH, in particular, have a higher risk of non-communicable comorbidities, including diabetes, hypertension, cardiovascular disease, and chronic lung disease than uninfected individuals of similar age. Older PLWH may not be the only members of the HIV seropositive population at risk for the negative health sequelae of COVID-19. Given recent developments that have shown the vulnerability of those ages 18–49 to COVID-19, younger PLWH may also be at heightened risk for mortality due to COVID-19 complications. Such risk is predicated on the fact that PLWH under age 50 are both less likely to be diagnosed (and in effect more likely to be immunocompromised) and also less likely to access and be retained in care, yielding viral suppression of a mere 37% on those age 25–34. Psychosocial Conditions and COVID-19 in People Living with HIV: PLWH have an increased likelihood of mental health burden, illicit drug use, and other STIs , all catalyzed by psychosocial burdens experienced at elevated rates in marginalized populations including sexual and gender minorities, racial and ethnic minorities, and/or the poor and underserved. While there is no standard set of psychosocial factors that are prescribed, burdens such as medical mistrust, loneliness, stigma, and hopelessness have been implicated in the propagation of disease. Older PLWH already experience heightened rates of loneliness and social isolation, compromising their social and emotional well-being and health in light of social distancing efforts, albeit sound epidemiological principles inform such efforts. Diminished neurocognitive functioning and heightened mental health burden evidence in older PLWH may impede effective self-care. Healthcare Access and COVID-19 in People Living with HIV: PLWH require regular engagement with the healthcare system to maintain viral suppression, which provides optimal clinical benefits and drastic reductions in HIV transmission. ART implementation and consistent adherence have improved the long-term health outcomes among PLWH, but they are vulnerable if interruptions in treatment occur due to the COVID-19 pandemic. In the Wuhan region of China, reports indicate PLWH have struggled to access ART during the COVID-19 outbreak due to the stigma and discrimination surrounding the HIV/AIDS epidemic in the country To read more-



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