Paul Brennan的图片来自Pixabay

在3月至2020年4月之间，SARS-COV-2在Brescia省伦巴第省（Lombardy意大利的前五省对于COVID-19案件的数量（每人1.4％100.000）。在大流行期间，医院面临越来越多的压力，在这种压力下，患有艾滋病毒的人有可能获得SARS-COV-2并打断艾滋病毒的护理连续性。

我们的观察性研究由布雷斯西亚大学助理Spedali Civili的传染和热带疾病系进行。

The study considered the number of visits carried out, antiretroviral drugs (ART) pack dispensed, new diagnoses and hospitalizations. We compared the data for the two-month period October-November 2019 with those of the two-month period March-April 2020. The research involved a group of 3,875 HIV-infected patients, with an average age of over 51 years.

Looking at the impact of COVID-19 through the lenses of UNAIDS 90-90-90 targets

In order to end the global AIDS epidemic, the UNAIDS has set an ambitious target called90-90-90，旨在确保所有患有艾滋病毒的人中有90％的人知道自己的状况，被诊断出的所有诊断患者中有90％将接受持续的抗逆转录病毒疗法（ART），并且所有接受艺术的人中有90％将受到病毒抑制。

布雷西亚于2020年7月签署了巴黎宣言the global Fast-Track Cities initiativewhich outlines a set of commitments to reach the 90-90-90 targets. HIV specialists need to review the current programs to identify the potential barriers that might hinder the achievement of these goals during SARS-CoV-2 pandemic.

第一个UNAIDS目标（所有艾滋病毒感染者中的90％都应该知道其艾滋病毒状况）是基于艾滋病毒测试，这是迈向艾滋病毒护理连续体的第一步。正如我们所观察到的那样，COVID-19-19的大流行对我们省的艾滋病毒筛查计划产生了负面影响。

这两个时期之间新的HIV诊断数量减少，从2019年的平均每月6.4到Covid-19的大流行中的二级疾病（p = 0.01）。其中，在两名患者的HIV诊断时，存在定义疾病的AIDS。2020年3月8日，意大利政府宣布实施社区遏制措施，以包含SARS-COV-2的扩散，其中包括社会疏远，运动限制和隔离。

Predictably, these measures drastically reduced the access to routine HIV testing. For a near future, it will be important to organize health services in order to guarantee a safe and continuous access to HIV testing, which is a fundamental health service and a detrimental step towards HIV elimination.

During the first COVID-19 wave, missed visits increased from 4.9% in 2019 to 8.1%. The good news is that over 67% of patients were able to carry out the control visit remotely over the phone, thanks to telemedicine programs.

The second target, (90% of all people with HIV diagnosis should be maintained linked to HIV care) is based on offering and maintaining HIV care in all HIV-infected patients. Our preliminary experience shows that the percentage of missed visits increased from 4.9% in 2019 to 8.1%, mainly women and immigrants, during the first wave of SARS-CoV-2 pandemic (p <0.01）在我们的中心。

However, the good news was that over 67% of patients scheduled in the period between March and April 2020, were able to carry out the control visit remotely via telephone interview, thanks to the introduction oftelemedicine程式。我们的经验可能是对稳定患者进行年度评估的新计划的开始。

第三个靶标（抑制病毒浆负荷的PLWH的90％）是基于确保PLWH可以使用抗逆转录病毒疗法并增强对ART的依从性的。

During the study period, a reduction of ART packs distributed was observed (- 23.1%), despite the contribution of numerous voluntary associations in home deliveries. The highest decrease was observed in people with non-Italian nationality compared to Italian nationality (− 27.4 vs − 20.1%,p <0.05）。

It is interesting to note that the overall decrease in drug packs withdrawals was lower in patients treated with protease inhibitors (- 16.6%), possibly due to the therapeutic role of these drugs in treating SARS-Cov-2 infection initially hypothesized and subsequently not confirmed. However, when we compared March and April separately, we observed a higher drop in drugs dispensation in March (− 33.6%) with a trend towards normalization in April (− 12.6%). In the next months, we will evaluate the impact of this reduction of drugs distribution on HIV viral load.

Clinical consequences of SARS-CoV-2 infection

要考虑的另一个指标是我们队列中SARS-COV-2感染的临床后果。分析表明，艾滋病毒阳性患者的住院治疗从2019年的7.7例患者/月增加到2020年3月至4月之间的12.5例患者/月份。其中48％由于SARS-COV-2感染而住院。

This study supports the hypothesis that telemedicine represents a useful tool to effectively contain the negative consequences in HIV-positive and in others patients affected by chronic conditions during emergency events.

However, HIV testing services and strategies need being supported and promoted even in critical periods. Women and immigrants turned out to be a population at risk in terms of the percentage of patients lost to follow-up during the emergency period, which is why more particular attention must be paid to these patients.

Thanks to the enormous commitment at the forefront of health care professionals, pharmacists and voluntary associations, the higher attention to these vulnerable populations during the emergency has limited the negative consequences on their health. Anyway, our experience highlights the importance of resilient health strategies and programs that can cope with exceptional events.