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

项目概要/摘要 由于 COVID-19 大流行，一场史无前例的公共卫生紧急情况正在全球范围内展开， 自 2020 年 3 月 26 日以来，美国一直是大流行的震中。此前没有出现过全球大流行 这一规模与艾滋病毒大流行在时间上重叠。尽管如此，鉴于惊人的速度 尽管大流行已经发展，但人们对 HIV 和 SARS-CoV-2 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 大流行是 通过破坏卫生系统、经济和卫生系统，威胁到联合国艾滋病规划署 90:90:90 艾滋病毒目标的全球成果 艾滋病毒感染者的健康。旧金山是美国第一个实施“就地避难”的城市 2020 年 3 月 16 日采取的公共卫生措施。考虑到需要限制亲自访问以遏制病毒传播 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 对于制定干预措施以减轻 COVID-19 的有害影响并为未来的流行病制定计划至关重要。 HIV 感染者 (PWH) 是否更容易或不太容易感染 COVID-19 或严重疾病尚不清楚； 严重 COVID-19 的一些危险因素（年龄较大、心血管疾病、肺部疾病）更多 艾滋病毒药物（如替诺福韦及其代谢物）可能具有保护作用。产后卫生时间 低收入地区的住房和粮食不安全程度极低，增加了传播风险。鉴于影响 艾滋病毒对免疫反应的影响，了解感染者是否对艾滋病毒的持久免疫力是否较低也很重要 感染后的 COVID-19。最后，COVID-19 对医疗和社会服务造成的影响 对于 PWH 来说，无论是在危机期间还是危机结束后，都需要进行紧急研究，因为 COVID-19 有可能 消除迄今为止在结束艾滋病毒流行方面取得的进展。 该提案将回答有关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 Ward 86 HIV 诊所，这是一个为公共保险 HIV 患者提供安全网的大型诊所 在旧金山，靠近发生集中的 COVID-19 流行病的社区。目标 1 将提供 迫切需要关于 SARS-CoV-2 感染风险、患病率和临床结果如何因人而异的新见解 HIV 状况和/或抗逆转录病毒治疗方案（即替诺福韦）。目标 2 将探讨 HIV 感染是否会损害 对 COVID-19 的体液或 T 细胞反应，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感染者的影响，包括病毒 镇压；保留护理；住院治疗、合并症结果和非 COVID-19 相关死亡； COVID019 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、药物使用、耻辱和复原力。运用、研究 UCFAR 的基础设施、全市范围的 COVID-19 登记处以及所服务的大量老龄化 PWH 人口 Ward 86 诊所，这笔赠款将立即开展高影响力的研究，以跟踪相互冲突的流行病。

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.