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

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Infectious Diseases

Infectious Diseases Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @InfectiousDz

2 Sep
Which countries are rolling out 3rd vaccine shots?
Israel offering 3rd doses currently to all vaccinated 12+
reuters.com/world/middle-e…
Starting in September, Germany will offer another dose of Pfizer or Moderna to older people, residents of care homes, and people with compromised immune systems — and also to anyone who was already fully vaccinated with the 2-dose AZ or single-dose J&J
nytimes.com/2021/08/02/wor…
Read 24 tweets
26 Aug
There are always minor anomalies created by how data is collected and reported.

and then there's whatever happened on August 23rd in Uganda's case count reporting by JHU, FT, and Our World in Data
This did not reflect what Uganda's MOH reported on the 23rd, but there can always be a backlog of cases being identified and reported.
This is important, not just for Uganda, which was hit early by Delta, but also in best preparing for Delta in nearby countries, as the variant has been more recently forming surges elsewhere in East Africa.
Read 4 tweets
25 Aug
Here's the start of a list of tweets announcing new vaccine mandates.
France - digital pass, vaccine or test for cafes, restaurants, museums etc foreignpolicy.com/2021/07/27/fra…
New York City - digital pass vaccine (any WHO approved) or test in last week for restaurants, bars, museums, theaters, gyms vox.com/recode/2021/8/…
Read 51 tweets
25 Aug
Oklahoma, this is bad.

Case positivity - 81.98%
Standing far above another other US state. 1/4 Image
Oklahoma - leading the nation in searches for ivermectin. Image
Case positivity has reached this high even with a rise in testing. Image
Read 12 tweets
23 Aug
Cote d'Ivoire has never been part a human Ebola epidemic. August 2021 has suddenly put Cote d'Ivoire in the middle of multiple contact tracing investigations. 1/n
In August 2021, a case was found in a traveler to Abidjan from Guinea, leading to investigation of contacts along route and in city. A new case is suspected in Burkina Faso and linked to an area as far as possible from Abidjan on northern Mali border Image
Hopefully the case in Burkina Faso is simply a suspected case which tests negative. This is quite possible. There are not enough characters to list here all the diagnoses that can look like Ebola - yellow fever, malaria, Lassa etc
Read 12 tweets
1 Jun
Vaccine equity is not just about ensuring more doses. It's about more doses into more arms

Vaccines don't inject themselves. Funding for distribution and vaccination crucial

Vaccines that arrive free just before expiration will be feared to be a dump of what others do not want
Some areas where vaccination rates are the lowest are also those where substandard excess have been dumped as donations in the past. The protective response has long been jettisoning anything close to the expiration date.
Malawi has already incinerated 20K doses of thee vaccine that arrived less than 3 wks before expiry. WHO and AU had encouraged keeping doses as considered fine until July
Read 10 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!

Follow Us on Twitter!

:(