Abstract
Background
The COVID-19 pandemic heightened concerns about people experiencing more depressive symptoms. Among people with HIV (PWH), who have higher rates of depression, these symptoms may ...lead to adverse HIV-related outcomes. This study sought to characterize the effects of the COVID-19 pandemic on depression severity and to investigate the association between depression trajectories and viral load (VL) non-suppression among PWH enrolled in HIV care.
Methods
The study sample was PWH in the Johns Hopkins HIV Clinical Cohort who reported depression symptoms on the Patient Health Questionnaire 8 (PHQ-8) via a self-administered survey pre-pandemic (Mar. 1, 2018 - Feb. 28, 2020) and during the COVID-era (Sept. 1, 2020 - Feb. 28, 2022). Depression severity was categorized using standard PHQ-8 cutoffs ranging from normal (0-4) to severe (20-24). Depression severity categories pre-pandemic (last survey) and COVID-era (earliest survey) were compared, and trajectories were classified as: 1) remained depressed (PHQ-8 > 4 and no change in severity category) or worsened (change to a higher severity category) and 2) remained non-depressed (PHQ-8 ≤ 4 and no change in severity category) or improved (change to a lower severity category). The association between depression trajectories and VL non-suppression (HIV RNA > 200 copies/ml on the first measurement after a COVID-era survey) was assessed using logistic regression adjusting for age, gender, pre-pandemic VL, clinical diagnosis of mood and substance use disorders.
Results
Among 793 PWH in this study, 60% were male, 88% were Black and the mean age was 56 years. Approximately 24% of PWH remained depressed (9%) or worsened (15%), while 76% remained non-depressed (60%) or improved (16%). PWH who remained depressed or worsened were more likely to be virally unsuppressed (adjusted odds ratio:2.45, 95% confidence interval: 1.19 – 5.06) compared to those who remained non-depressed or improved.
Conclusion
In our cohort of PWH, a quarter either remained consistently depressed or experienced worsening depression in the COVID-era. Depression was significantly associated with VL non-suppression during the pandemic. Our findings suggest that strategies to monitor and address depression symptoms among PWH may contribute to reduced risk of VL non-suppression.
Disclosures
Oluwaseun Falade-Nwulia, MBBS ,MPH, Abbvie Inc: Grant/Research Support|Gilead Sciences: Advisor/Consultant
Abstract
Background
During the COVID-19 pandemic, patients at the John G. Bartlett Specialty practice experienced disruptions in viral load (VL) monitoring due to 1) conversion to telemedicine visits ...and 2) closure of the onsite lab from March 16-July 13, 2021. We described the impact of the pandemic on VL monitoring.
Methods
We measured time from all index VLs collected during 3 periods: January 1, 2019 to March 15, 2020 (pre-pandemic); March 16 to July 12, 2020 (pandemic, closed onsite lab); and July 13 to December 31, 2020 (pandemic, open onsite lab) until a subsequent VL, 1 year after the index VL, or administrative censoring on December 31, 2020, whichever came first. We classified follow-up time according to these periods (treating period as a time-varying variable). We report hazard ratios (HRs) and 95% Confidence Intervals (CI) from a Cox proportional hazards model comparing the hazard of a VL during the pandemic periods to the pre-pandemic period, stratified by whether the index VL was suppressed (≤200 copies/mL). We tested for interactions between patient characteristics (age, sex at birth, race, ethnicity, and recent substance use) and period, to investigate differential effects of the pandemic on delayed VL.
Results
After 7,760 suppressed VL measurements, median times to subsequent VL during the pre-pandemic, pandemic (closed lab) and pandemic (open lab) periods, were 4.6 (HR=1.0), 8.9 (HR=0.34, CI:0.30, 0.37), and 5.8 (HR=0.73, CI:0.68,0.78) months respectively. After 1,025 non-suppressed VL measurements, median times to subsequent VL were 2.0 (HR=1.0), 3.9 (HR=0.57, CI:0.42,0.79), and 2.1 (HR=0.92, CI:0.76,1.10) months respectively. Time to subsequent VL after an index suppressed VL was less affected by the pandemic for patients who are white; had private insurance; or had no recent cocaine or heroin use. The effect of the pandemic on time to subsequent VL after a non-suppressed index VL did not significantly differ across patient characteristics.
Conclusion
Onsite lab closure disrupted VL collection for all groups. Once the onsite lab opened, the pandemic period was still associated with a delay among suppressed patients, but not non-suppressed patients. Further studies are needed to investigate if these delays are associated with lapses in viral suppression.
Disclosures
All Authors: No reported disclosures
The prevalence of tobacco smoking among people with HIV (PWH) ranges from 40% to 70%. Additionally, tobacco smoking is higher among low-income individuals, yet few studies have examined tobacco ...smoking in low socioeconomic status PWH. Using data from a cohort of PWH receiving care in an urban HIV clinic, we characterized factors associated with current and former smoking and with initiation/re-initiation and cessation of tobacco use. Among a study sample of 1,607 PWH, the prevalence of current smoking was 46.6% among men and 46.0% among women. Current smoking in men and women was associated with Medicaid insurance status, substance use, and panic symptoms. In women, but not men, hazardous alcohol use decreased the likelihood of quitting smoking and increased the risk of initiation/re-initiation. Smoking interventions for low-income, urban PWH may need to be tailored to address mental health and substance use comorbidities.
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