Challenges in HIV care at a tertiary hospital repurposed for COVID-19: an observational study (2019-2022).

BACKGROUND: The COVID-19 pandemic disrupted global healthcare systems, reducing access to care for people with chronic conditions, including HIV. In Mexico, the National Institute of Respiratory Diseases (INER) was fully repurposed as a COVID-19 referral center, interrupting routine HIV services. CIENI, an HIV clinic within INER, implemented mitigation strategies to preserve care for people living with HIV (PLWH). Concurrently, national guidelines introduced BIC/FTC/TAF as the new first-line antiretroviral regimen in 2019. We aimed to assess the impact of INER’s reconversion on clinical outcomes of PLWH, within the context of newly adopted treatment guidelines. METHODS: We conducted a retrospective, repeated cross-sectional study at an specialized HIV clinic located inside the largest referral center for complicated COVID-19 nationally. Three periods were defined: pre-pandemic (Jan 2019–Feb 2020), pandemic (Mar 2020–Dec 2021), and post-pandemic (Jan–Dec 2022). Outcomes included HIV-related clinical markers (viral load, CD4), follow-up indicators (adherence, antiretroviral [ART] delivery, treatment abandonment, hospitalization, referrals, death), chronic comorbidities (hypertension, obesity, dyslipidemia, diabetes, cancer), and common infections (syphilis, HBV, HCV, TB). Statistical comparisons between pre- and post-pandemic periods included bivariate analyses, linear regression model on hospitalization rates change, and logistic regression for weight gain after ART regimen change. All analyses were conducted in R. RESULTS: Among 700 PLWH (85.7% men), 79.2% continued care at our center, 13.9% were referred elsewhere, 6.9% were lost to follow-up and 2% died. During repurposing, HIV testing, ART initiation, on-site consultations, and non-COVID-19 hospitalizations were suspended. The proportion with CD4 < 200 cells/µL decreased from 10.8% to 6.1% (p = 0.004), while undetectable viral load frequencies remained stable (90.4% vs. 90.7%, p = 0.421). Dyslipidemia increased from 65.3% to 77.8% (p < 0.001), and obesity from 11.3% to 20.2% (p < 0.001). No significant association was observed between BIC/FTC/TAF use and BMI change in the post-pandemic period. Frequencies of cancer, tuberculosis, HBV, and HCV declined, likely due to limited screening (all p < 0.014). Mitigation strategies included multi-month ART dispensation, hospitalization agreements, and telemedicine. CONCLUSIONS: Locally-implemented strategies and ART switch sustained HIV control and reduced mortality, but comorbidities were insufficiently addressed. Timely access to HIV care should be prioritized in future crises.