The intertwined epidemics of HIV and COVID-19 - emerging data and responses.
The intertwined epidemics of HIV and COVID-19 - emerging data and responses.
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HIV 和 COVID-19 相互交织的流行病 - 新出现的数据和应对措施。
DOI：
10.1097/coh.0000000000000792
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发表时间：
2023
影响因子：
4.1
通讯作者：
Riva,Agostino
中科院分区：
文献类型：
--
作者：
Spinelli,Matthew;Gandhi,Monica;Riva,Agostino
迄今为止，严重急性呼吸系统综合征冠状病毒2 （SARS-CoV-2）规模的全球大流行尚未与人类免疫缺陷病毒（HIV）流行重叠，这对生物医学科学提出了挑战，要求调整医疗保健基础设施、公共卫生应对措施和研究，以应对2019年冠状病毒病（COVID-19）。不幸的是，SARS-CoV-2大流行导致抗逆转录病毒疗法缺货，实验室检测和监测的可及性减少，并对艾滋病毒感染者和一般人群产生了深远的社会经济影响。除了对全球控制艾滋病毒流行受挫的担忧之外，人们还担心艾滋病毒感染者对SARS-CoV-2感染的易感性。尽管艾滋病毒未得到良好控制者的免疫抑制、较高的合并症发生率以及健康社会决定因素的不同影响，使得PLWH发生严重SARS-CoV-2感染及其后遗症的风险增加，但SARS-CoV-2疫苗接种已成为预防PLWH发病率和死亡率的关键策略。PWLH已被证明对COVID-19疫苗具有出色的免疫应答，尽管那些CD4计数较低的人将需要持续加强疫苗接种。不幸的是，艾滋病毒流行率最高的地区获得SARS-CoV-2疫苗的机会较少，这导致了PLWH中可预防的死亡，并凸显了全球COVID-19应对措施中的不公平现象。尽管与卫生保健系统的接触程度较高，但PLWH也不能免于疫苗犹豫，其交叉的类别和身份包括政治意识形态，对卫生保健系统的信任和参与，以及过去在获得医疗保健方面的种族主义和耻辱经历，导致疫苗信心低下。最近的数据显示，疫苗接种率较低，特别是在没有实现病毒学抑制的PLWH中，这两者都可能源于医学上的不信任。显然，需要制定策略来提高病毒学抑制率，并采取综合疾病预防和合并症治疗，以避免PWLH之间的健康差距进一步扩大。有可能在SARS-CoV-2病毒种群中出现新的突变
No prior global pandemic on the scale of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has overlapped with the human immunodeficiency virus (HIV) epidemic to date, challenging biomedical science to adapt the infrastructure of healthcare, public health responses, and research to respond to coronavirus Disease 2019 (COVID-19). Unfortunately, the SARS-CoV-2 pandemic has led to stockouts of antiretroviral therapy, decreased access to laboratory testing and monitoring, and profound socioeconomic impacts on both people living with HIV (PLWH) and the general population. Adding to fears about setbacks in the global control of the HIV epidemic were concerns about the susceptibility of people living with HIV to SARS-CoV-2 infection. Although PLWH are at increased risk of severe SARS-CoV-2 infection and its sequelae, driven in part by immunosuppression in those without well controlled HIV, higher rates of comorbidities, and the differential impact of the social determinants of health, SARS-CoV-2 vaccination has emerged as a key strategy to prevent morbidity and mortality among PLWH.PWLH have been demonstrated to have excellent immunologic responses to COVID-19 vaccines, although those with lower cluster of differentiation 4 (CD4) counts will need ongoing booster vaccination. Unfortunately, regions with the highest HIV prevalence have had less access to SARS-CoV-2 vaccination, which has contributed to preventable deaths among PLWH and highlights inequities in the global COVID-19 response. Despite higher engagement with healthcare systems, PLWH are not immune to vaccine hesitancy, with intersecting categories and identities including political ideology, trust and engagement with the healthcare system, and the past experience of racism and stigma in accessing medical care contributing to low vaccine confidence. Recent data has shown lower vaccine uptake especially among PLWH who have not achieved virologic suppression, both likely stemming from medical mistrust. There is obviously a need for strategies to both improve virologic suppression rates and uptake of comprehensive disease prevention and comorbidity treatments to avoid the worsening of health disparities among PWLH. With the potential for the emergence of novel mutations in SARS-CoV-2 viral populations