Evaluation of the Interplay between HIV and COVID-19 in a large urban safety-net HIV clinic

项目概要/摘要 由COVID-19大流行引起的前所未有的公共卫生紧急情况正在全球范围内展开， 美国自二零二零年三月二十六日起成为疫情中心。以前没有全球大流行 这一规模与艾滋病大流行在时间上重叠。尽管如此，考虑到惊人的速度， 尽管艾滋病毒和SARS-CoV-2之间的相互作用已经发展，但人们对它们之间的相互作用知之甚少。 鉴于COVID-19最近才进入艾滋病毒高流行地区。COVID-19疫情 通过破坏卫生系统、经济和环境，威胁到联合国艾滋病规划署90：90：90艾滋病毒目标的全球收益。 艾滋病毒感染者的健康。弗朗西斯科是美国第一个强制实施“就地安置”的城市。 2020年3月16日的公共卫生措施。鉴于有必要限制亲自访问，以防止 COVID-19，对艾滋病毒结果，护理保留和社会行为结果的影响的研究将 这对于制定干预措施以减轻COVID-19的有害影响并为未来的大流行病做好规划至关重要。 艾滋病毒感染者（PWH）是否更易感染COVID-19或严重疾病尚不清楚; 严重COVID-19的一些风险因素（年龄较大，心血管疾病，肺部疾病） 但艾滋病毒药物如替诺福韦及其代谢物可能具有保护作用。PWH在 低收入环境中的住房和粮食不安全程度很低，增加了传播风险。考虑到 此外，我们亦须了解威尔斯亲王医院对爱滋病病毒的持久免疫力会否因 COVID-19感染后。最后，COVID-19对医疗和社会服务造成的影响 在危机期间和危机之后，由于COVID-19有可能 消除迄今为止在终止艾滋病毒流行方面取得的进展。 这项提议将回答有关这两种病毒之间相互作用的三个重要问题。的 研究地点将设在86号病房艾滋病诊所，这是一家为公共保险的艾滋病患者提供安全网的大型诊所 在弗朗西斯科，靠近COVID-19疫情集中的社区。目标1将提供 新的，迫切需要的见解，如何SARS-CoV-2感染的风险，患病率和临床结果的变化， HIV状态和/或抗逆转录病毒治疗方案（即替诺福韦）。目标2将探讨艾滋病毒感染是否会损害 体液或T细胞对COVID-19的反应，为治疗和疫苗开发提供见解。目标3 数据将评估医疗保健和社会支持系统中断对PWH的影响，包括病毒 抑制;继续护理;住院、合并症结局和非COVID-19相关死亡; COVID 019期间的医疗保健利用;以及社交距离期间和之后的社会行为结果， 评估孤立、粮食不安全、压力、物质使用、耻辱和复原力。利用，研究 UCFAR的基础设施，全市COVID-19登记处，以及PWH服务的大量老龄化人口 在Ward 86诊所，这笔赠款将立即投入高影响力的研究，以跟踪相互碰撞的流行病。

PROJECT SUMMARY/ ABSTRACT An unprecedented public health emergency due to the COVID-19 pandemic is unfolding worldwide and the United States has been the epicenter of the pandemic since March 26, 2020. No prior global pandemic of this scale has overlapped temporally with the HIV pandemic. Despite this, given the breathtaking speed at which the pandemic has progressed, very little is known about the interplay between HIV and SARS-CoV-2 given that COVID-19 has only recently entered areas of high HIV prevalence. The COVID-19 pandemic is threatening worldwide gains in UNAIDS 90:90:90 targets for HIV by disrupting health systems, economies, and the health of people with HIV. San Francisco was the first city in the U.S. to impose “shelter in place” public health measures on March 16, 2020. Given the need to limit in-person visits to counter the spread of COVID-19, research on the impact on HIV outcomes, retention in care, and sociobehavioral outcomes will be crucial to develop interventions to attenuate COVID-19's deleterious impact and to plan for future pandemics. Whether people with HIV (PWH) are more or less susceptible to COVID-19 or severe disease is unknown; some of the risk factors for severe COVID-19 (older age, cardiovascular disease, pulmonary disease) are more prevalent among PWH but HIV medications such as tenofovir and its metabolites could be protective. PWH in low-income settings have marginal housing and food insecurity, increasing transmission risk. Given the impact of HIV on immune responses, it is also important to understand if PWH will have less durable immunity against COVID-19 following infection. Finally, the impact of the COVID-19's disruption of medical and social services for PWH needs urgent study, both during the crisis and in its aftermath, since COVID-19 has the potential to eradicate the progress made on Ending the HIV Epidemic to date. This proposal will answer three vital questions concerning the interplay between the two viruses. The site of the study will be at the Ward 86 HIV Clinic, a large safety-net clinic for publicly-insured patients with HIV in San Francisco, near the neighborhoods experiencing concentrated COVID-19 epidemics. Aim 1 will provide novel, urgently needed insights into how SARS-CoV-2 infection risk, prevalence and clinical outcomes vary by HIV status and/or antiretroviral regimen (i.e. tenofovir). Aim 2 will explore whether HIV infection will impair humoral or T-cell responses to COVID-19, providing insights for therapeutic and vaccine development. Aim 3 data will evaluate the impact of disruption of healthcare and social support systems on PWH, including viral suppression; retention in care; hospitalizations, co-morbidity outcomes, and non-COVID-19 related death; healthcare utilization during COVID019; and socio-behavioral outcomes during and after social distancing to assess isolation, food insecurity, stress, substance use, stigma, and resilience. Harnessing, the research infrastructure of the UCFAR, citywide COVID-19 registries, and a large, aging population of PWH served by the Ward 86 clinic, this grant will put immediate, high-impact studies in place to track the colliding pandemics.