Thread by @InfectiousDz

HIV made the news because yet another vaccine failed. The real story is the impact of COVID on HIV and in turn on COVID. Roll out of a new med worldwide, dolutegravir, delayed. Many missed appointments, refills, doses. Others weren't diagnosed.
This impacts not just HIV but COVID

The cascade of HIV care - learning diagnosis, starting treatment, returning for appointments and viral load testing, adherence, HIV viral suppression - has had interruptions over the past 1.5 years worldwide.

Worldwide we have seen drop offs in service delivery along this cascade of care.
theglobalfight.org/covid-aids-tb-…
This means people are missing their diagnosis, their meds, their control of the virus, and the chance to be healthy and also non-infectious

Even in San Francisco, California, COVID has meant a drop off in testing:
sfdph.org/dph/files/repo…

In San Francisco, California, we have seen a drop off in testing for viral load (ie used to document control of the virus in those on treatment, which adherence concerns and resistance can undermine)

The goal of the cascade of care is to have everyone diagnosed, on treatment, and virally suppressed (ie the virus can't be detected, keeping the individual healthy and also no-infectious).
We aim for 90-90-90

90-90-90 is:
90% of those infected tested and know their diagnosis
90% of those who know their diagnosis are on treatment
90% on treatment are virally suppressed
This means actually 90-81-72
It's hard, but countries around the world have surpassed this.
COVID makes it harder. SF:

On a global scale, COVID and all its interruptions and reprioritizations has made it harder for folks to be tested, access treatment and stay on treatment
unaids.org/en/resources/p…

There also was supposed to be a greater roll out of Dolutegravir to overcome resistance and ensure those on treatment suppressed the virus. This roll out much of it slated for 2020 was made harder by COVID.
thelancet.com/journals/lanhi…
ncbi.nlm.nih.gov/pmc/articles/P…
state.gov/wp-content/upl…

In those who are severely immunocompromised, including those with uncontrolled advanced HIV (not on meds, not on meds consistently, or have resistance) there is the risk of prolonged infection with SARS-CoV2.

We have even seen real time development of a new SARS-CoV2 variant in someone with HIV who needed dolutegravir, as was failing an efavirenz based regimen, and persistently was infected with SARS-CoV2 until starting dolutegravir and controlling HIV
krisp.org.za/publications.p…

The most recent variant discussed in South Africa is also thought to have undergone mutations primarily in one individual. medrxiv.org/content/10.110…
theconversation.com/theres-no-need…

Health is a shared resource, a global good.

Those with HIV or at high risk for HIV deserve resources for prevention and treatment. Treatment is in fact prevention.

COVID magnifies this. Variants will continue to develop. Protecting the immunocompromised is part of ending this