Publicação
HIV and SARS-CoV-2
| Resumo: | Concern is justified observing the link between the AIDS and COVID-19 pandemics. COVID-19 outcomes are significantly worse in many people living with HIV (PLHIV), even when vaccinated, because of their impaired immune system. Moreover, CD4 T-cells are affected by both HIV and SARS-CoV-2.1-3 SARS-CoV-2 variants can evolve in immunosuppressed patients due to prolonged viral replication in the context of an inadequate immune response.4 Accelerated intrahost evolution of SARS-CoV-2 was reported in a South African HIV patient with antiretroviral therapy (ART) failure.5 6 With 25 million HIV patients in sub-Saharan Africa (SSA) of whom an estimated 8 million are not virologically suppressed, this potentially creates a reservoir for future variants. Such variants, arising in PLHIV anywhere in the world, can spread to other continents, as has been reported for variants of concern (VoCs) (Beta, Omicron) and variants of interest (B.1.6.20, B.1.640.2) that arose in Africa.7-9 Conversely, the COVID-19 pandemic impacts HIV treatment programmes, due to supply chain issues, overburdening of healthcare systems, limiting access to testing, treatment and prevention programmes and further increasing inequalities.10 Modelled COVID-19 disruptions of HIV programmes in SSA included decreased functionality of HIV prevention programmes, HIV testing and treatment, healthcare services such as viral load testing, adherence counselling, drug regimen switches and ART interruptions, which may lead to selection of drug-resistant HIV.11 A 6-month interruption affecting 50% of the population would lead to a median number of excess deaths of 296 000, during 1 year. Scientists advocate for the AIDS and COVID-19 pandemics in Africa to be addressed simultaneously, by increasing African access to COVID-19 vaccines, prioritising research on the interaction between HIV care and COVID-19, maintaining high-quality HIV services and integrating health services for both viruses.7 Both the COVID-19 and the AIDS pandemic, more specifically the issue of HIV drug resistance (HIVDR), have previously been described as wicked problems which are best studied as complex adaptive systems (CASs).12-15Wicked problems consist of diverse interconnected factors and require complexity-informed and locally adapted solutions rather than one solution that fits all. We recently designed a qualitative model of all known factors influencing HIVDR in SSA and analysed its complexity.13 Our detailed systems map featured three main feedback loops driving HIVDR, representing (1) the alternation between adherence and non-adherence, (2) the impact of an overburdened healthcare system and (3) the importance of sustaining global efforts of tackling HIVDR even when new antiretroviral drugs with high genetic barriers become available. These HIV-related feedback loops are interconnected with COVID-19 pandemic impact (in yellow, figure 1). The loop starts from PLHIV with an unsuppressed viral load, which weakens the immune system and may in turn slow down immune clearance of SARS-CoV-2, allowing prolonged replication and mutation of the virus in the context of an inadequate immune response. Prolonged viral clearance facilitates the selection of immune escape SARS-CoV-2 variants. Variants may emerge that have a selective advantage and therefore may spread through populations due to increased transmissibility (with possibly increased virulence), thereby creating an additional burden on the healthcare system, putting the overall healthcare system and the HIV care at risk. These stressors on the healthcare system lead to a higher risk of unsuppressed viral load in PLHIV, increasing the risk of HIVDR. Figure 1 shows the need to address both wicked problems simultaneously and to do so in a complexity-informed manner as they are inevitably linked and influence each other. Evidently, the exact interconnections between both pandemics need to be locally assessed. For instance, a study in South Africa showed that while lockdown severely impacted HIV testing and ART initiation, ART provision was largely maintained, indicating that the strength of the connection between the virological suppression-related loop and the pandemic, indicated in figure 1, are context-dependent.16 |
|---|---|
| Autores principais: | Kiekens, Anneleen |
| Outros Autores: | Bwire, George Msema; Decouttere, Catherine; Jordan, Michael R.; Mangara, Ally; Mosha, Idda H.; Rinke De Wit, Tobias; Sangeda, Raphael Zozimus; Swalehe, Omary; Vandaele, Nico; Killewo, Japhet; Vandamme, Anne Mieke |
| Assunto: | COVID-19 health systems HIV RA0421 Public health. Hygiene. Preventive Medicine QR355 Virology Health Policy Public Health, Environmental and Occupational Health SDG 3 - Good Health and Well-being SDG 16 - Peace, Justice and Strong Institutions SDG 17 - Partnerships for the Goals |
| Ano: | 2022 |
| País: | Portugal |
| Tipo de documento: | artigo |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Universidade Nova de Lisboa |
| Idioma: | inglês |
| Origem: | Repositório Institucional da UNL |
| _version_ | 1879447299802791936 |
|---|---|
| author | Kiekens, Anneleen |
| author2 | Bwire, George Msema Decouttere, Catherine Jordan, Michael R. Mangara, Ally Mosha, Idda H. Rinke De Wit, Tobias Sangeda, Raphael Zozimus Swalehe, Omary Vandaele, Nico Killewo, Japhet Vandamme, Anne Mieke |
| author2_role | author author author author author author author author author author author |
| author_facet | Kiekens, Anneleen Bwire, George Msema Decouttere, Catherine Jordan, Michael R. Mangara, Ally Mosha, Idda H. Rinke De Wit, Tobias Sangeda, Raphael Zozimus Swalehe, Omary Vandaele, Nico Killewo, Japhet Vandamme, Anne Mieke |
| author_role | author |
| contributor_name_str_mv | Instituto de Higiene e Medicina Tropical (IHMT) Global Health and Tropical Medicine (GHTM) TB, HIV and opportunistic diseases and pathogens (THOP) Universidade NOVA de Lisboa BMJ Publishing Group RUN |
| country_str | PT |
| creators_json_txt | [{\"Person.name\":\"Kiekens, Anneleen\"},{\"Person.name\":\"Bwire, George Msema\"},{\"Person.name\":\"Decouttere, Catherine\"},{\"Person.name\":\"Jordan, Michael R.\"},{\"Person.name\":\"Mangara, Ally\"},{\"Person.name\":\"Mosha, Idda H.\"},{\"Person.name\":\"Rinke De Wit, Tobias\"},{\"Person.name\":\"Sangeda, Raphael Zozimus\"},{\"Person.name\":\"Swalehe, Omary\"},{\"Person.name\":\"Vandaele, Nico\"},{\"Person.name\":\"Killewo, Japhet\"},{\"Person.name\":\"Vandamme, Anne Mieke\"}] |
| datacite.contributors.contributor.contributorName.fl_str_mv | Instituto de Higiene e Medicina Tropical (IHMT) Global Health and Tropical Medicine (GHTM) TB, HIV and opportunistic diseases and pathogens (THOP) Universidade NOVA de Lisboa BMJ Publishing Group RUN |
| datacite.creators.creator.creatorName.fl_str_mv | Kiekens, Anneleen Bwire, George Msema Decouttere, Catherine Jordan, Michael R. Mangara, Ally Mosha, Idda H. Rinke De Wit, Tobias Sangeda, Raphael Zozimus Swalehe, Omary Vandaele, Nico Killewo, Japhet Vandamme, Anne Mieke |
| datacite.date.Accepted.fl_str_mv | 2022-08-02T00:00:00Z |
| datacite.date.available.fl_str_mv | 2023-01-25T22:16:58Z |
| datacite.date.embargoed.fl_str_mv | 2023-01-25T22:16:58Z |
| datacite.rights.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| datacite.subjects.subject.fl_str_mv | COVID-19 health systems HIV RA0421 Public health. Hygiene. Preventive Medicine QR355 Virology Health Policy Public Health, Environmental and Occupational Health SDG 3 - Good Health and Well-being SDG 16 - Peace, Justice and Strong Institutions SDG 17 - Partnerships for the Goals |
| datacite.titles.title.fl_str_mv | HIV and SARS-CoV-2 the interplay of two wicked problems |
| dc.contributor.none.fl_str_mv | Instituto de Higiene e Medicina Tropical (IHMT) Global Health and Tropical Medicine (GHTM) TB, HIV and opportunistic diseases and pathogens (THOP) Universidade NOVA de Lisboa BMJ Publishing Group RUN |
| dc.creator.none.fl_str_mv | Kiekens, Anneleen Bwire, George Msema Decouttere, Catherine Jordan, Michael R. Mangara, Ally Mosha, Idda H. Rinke De Wit, Tobias Sangeda, Raphael Zozimus Swalehe, Omary Vandaele, Nico Killewo, Japhet Vandamme, Anne Mieke |
| dc.date.Accepted.fl_str_mv | 2022-08-02T00:00:00Z |
| dc.date.available.fl_str_mv | 2023-01-25T22:16:58Z |
| dc.date.embargoed.fl_str_mv | 2023-01-25T22:16:58Z |
| dc.format.none.fl_str_mv | application/pdf |
| dc.identifier.none.fl_str_mv | http://hdl.handle.net/10362/148174 |
| dc.language.none.fl_str_mv | eng |
| dc.rights.none.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| dc.subject.none.fl_str_mv | COVID-19 health systems HIV RA0421 Public health. Hygiene. Preventive Medicine QR355 Virology Health Policy Public Health, Environmental and Occupational Health SDG 3 - Good Health and Well-being SDG 16 - Peace, Justice and Strong Institutions SDG 17 - Partnerships for the Goals |
| dc.title.fl_str_mv | HIV and SARS-CoV-2 the interplay of two wicked problems |
| dc.type.none.fl_str_mv | http://purl.org/coar/resource_type/c_6501 |
| description | Concern is justified observing the link between the AIDS and COVID-19 pandemics. COVID-19 outcomes are significantly worse in many people living with HIV (PLHIV), even when vaccinated, because of their impaired immune system. Moreover, CD4 T-cells are affected by both HIV and SARS-CoV-2.1-3 SARS-CoV-2 variants can evolve in immunosuppressed patients due to prolonged viral replication in the context of an inadequate immune response.4 Accelerated intrahost evolution of SARS-CoV-2 was reported in a South African HIV patient with antiretroviral therapy (ART) failure.5 6 With 25 million HIV patients in sub-Saharan Africa (SSA) of whom an estimated 8 million are not virologically suppressed, this potentially creates a reservoir for future variants. Such variants, arising in PLHIV anywhere in the world, can spread to other continents, as has been reported for variants of concern (VoCs) (Beta, Omicron) and variants of interest (B.1.6.20, B.1.640.2) that arose in Africa.7-9 Conversely, the COVID-19 pandemic impacts HIV treatment programmes, due to supply chain issues, overburdening of healthcare systems, limiting access to testing, treatment and prevention programmes and further increasing inequalities.10 Modelled COVID-19 disruptions of HIV programmes in SSA included decreased functionality of HIV prevention programmes, HIV testing and treatment, healthcare services such as viral load testing, adherence counselling, drug regimen switches and ART interruptions, which may lead to selection of drug-resistant HIV.11 A 6-month interruption affecting 50% of the population would lead to a median number of excess deaths of 296 000, during 1 year. Scientists advocate for the AIDS and COVID-19 pandemics in Africa to be addressed simultaneously, by increasing African access to COVID-19 vaccines, prioritising research on the interaction between HIV care and COVID-19, maintaining high-quality HIV services and integrating health services for both viruses.7 Both the COVID-19 and the AIDS pandemic, more specifically the issue of HIV drug resistance (HIVDR), have previously been described as wicked problems which are best studied as complex adaptive systems (CASs).12-15Wicked problems consist of diverse interconnected factors and require complexity-informed and locally adapted solutions rather than one solution that fits all. We recently designed a qualitative model of all known factors influencing HIVDR in SSA and analysed its complexity.13 Our detailed systems map featured three main feedback loops driving HIVDR, representing (1) the alternation between adherence and non-adherence, (2) the impact of an overburdened healthcare system and (3) the importance of sustaining global efforts of tackling HIVDR even when new antiretroviral drugs with high genetic barriers become available. These HIV-related feedback loops are interconnected with COVID-19 pandemic impact (in yellow, figure 1). The loop starts from PLHIV with an unsuppressed viral load, which weakens the immune system and may in turn slow down immune clearance of SARS-CoV-2, allowing prolonged replication and mutation of the virus in the context of an inadequate immune response. Prolonged viral clearance facilitates the selection of immune escape SARS-CoV-2 variants. Variants may emerge that have a selective advantage and therefore may spread through populations due to increased transmissibility (with possibly increased virulence), thereby creating an additional burden on the healthcare system, putting the overall healthcare system and the HIV care at risk. These stressors on the healthcare system lead to a higher risk of unsuppressed viral load in PLHIV, increasing the risk of HIVDR. Figure 1 shows the need to address both wicked problems simultaneously and to do so in a complexity-informed manner as they are inevitably linked and influence each other. Evidently, the exact interconnections between both pandemics need to be locally assessed. For instance, a study in South Africa showed that while lockdown severely impacted HIV testing and ART initiation, ART provision was largely maintained, indicating that the strength of the connection between the virological suppression-related loop and the pandemic, indicated in figure 1, are context-dependent.16 |
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| person_str_mv | Kiekens, Anneleen Bwire, George Msema Decouttere, Catherine Jordan, Michael R. Mangara, Ally Mosha, Idda H. Rinke De Wit, Tobias Sangeda, Raphael Zozimus Swalehe, Omary Vandaele, Nico Killewo, Japhet Vandamme, Anne Mieke |
| publishDate | 2022 |
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| spelling | engenConcern is justified observing the link between the AIDS and COVID-19 pandemics. COVID-19 outcomes are significantly worse in many people living with HIV (PLHIV), even when vaccinated, because of their impaired immune system. Moreover, CD4 T-cells are affected by both HIV and SARS-CoV-2.1-3 SARS-CoV-2 variants can evolve in immunosuppressed patients due to prolonged viral replication in the context of an inadequate immune response.4 Accelerated intrahost evolution of SARS-CoV-2 was reported in a South African HIV patient with antiretroviral therapy (ART) failure.5 6 With 25 million HIV patients in sub-Saharan Africa (SSA) of whom an estimated 8 million are not virologically suppressed, this potentially creates a reservoir for future variants. Such variants, arising in PLHIV anywhere in the world, can spread to other continents, as has been reported for variants of concern (VoCs) (Beta, Omicron) and variants of interest (B.1.6.20, B.1.640.2) that arose in Africa.7-9 Conversely, the COVID-19 pandemic impacts HIV treatment programmes, due to supply chain issues, overburdening of healthcare systems, limiting access to testing, treatment and prevention programmes and further increasing inequalities.10 Modelled COVID-19 disruptions of HIV programmes in SSA included decreased functionality of HIV prevention programmes, HIV testing and treatment, healthcare services such as viral load testing, adherence counselling, drug regimen switches and ART interruptions, which may lead to selection of drug-resistant HIV.11 A 6-month interruption affecting 50% of the population would lead to a median number of excess deaths of 296 000, during 1 year. Scientists advocate for the AIDS and COVID-19 pandemics in Africa to be addressed simultaneously, by increasing African access to COVID-19 vaccines, prioritising research on the interaction between HIV care and COVID-19, maintaining high-quality HIV services and integrating health services for both viruses.7 Both the COVID-19 and the AIDS pandemic, more specifically the issue of HIV drug resistance (HIVDR), have previously been described as wicked problems which are best studied as complex adaptive systems (CASs).12-15Wicked problems consist of diverse interconnected factors and require complexity-informed and locally adapted solutions rather than one solution that fits all. We recently designed a qualitative model of all known factors influencing HIVDR in SSA and analysed its complexity.13 Our detailed systems map featured three main feedback loops driving HIVDR, representing (1) the alternation between adherence and non-adherence, (2) the impact of an overburdened healthcare system and (3) the importance of sustaining global efforts of tackling HIVDR even when new antiretroviral drugs with high genetic barriers become available. These HIV-related feedback loops are interconnected with COVID-19 pandemic impact (in yellow, figure 1). The loop starts from PLHIV with an unsuppressed viral load, which weakens the immune system and may in turn slow down immune clearance of SARS-CoV-2, allowing prolonged replication and mutation of the virus in the context of an inadequate immune response. Prolonged viral clearance facilitates the selection of immune escape SARS-CoV-2 variants. Variants may emerge that have a selective advantage and therefore may spread through populations due to increased transmissibility (with possibly increased virulence), thereby creating an additional burden on the healthcare system, putting the overall healthcare system and the HIV care at risk. These stressors on the healthcare system lead to a higher risk of unsuppressed viral load in PLHIV, increasing the risk of HIVDR. Figure 1 shows the need to address both wicked problems simultaneously and to do so in a complexity-informed manner as they are inevitably linked and influence each other. Evidently, the exact interconnections between both pandemics need to be locally assessed. For instance, a study in South Africa showed that while lockdown severely impacted HIV testing and ART initiation, ART provision was largely maintained, indicating that the strength of the connection between the virological suppression-related loop and the pandemic, indicated in figure 1, are context-dependent.16application/pdfenHIV and SARS-CoV-2Subtitleenthe interplay of two wicked problemsKiekens, AnneleenBwire, George MsemaDecouttere, CatherineJordan, Michael R.Mangara, AllyMosha, Idda H.Rinke De Wit, TobiasSangeda, Raphael ZozimusSwalehe, OmaryVandaele, NicoKillewo, JaphetVandamme, Anne MiekeInstituto de Higiene e Medicina Tropical (IHMT)Global Health and Tropical Medicine (GHTM)TB, HIV and opportunistic diseases and pathogens (THOP)Universidade NOVA de LisboaBMJ Publishing GroupHostingInstitutionOrganizationalRUNe-mailmailto:run@unl.ptrun@unl.ptISSNIsPartOf2059-7908URNIsPartOfPURE: 50802266URNIsPartOfPURE UUID: e88b9bdd-ac9b-4346-8f10-100333f1b0b9URNIsPartOfScopus: 85135966056URNIsPartOfPubMed: 35918073URNIsPartOfWOS: WOS:000835754600003DOIIsPartOf10.1136/bmjgh-2022-0091052023-01-25T22:16:58Z2022-08-022022-08-02T00:00:00ZHandlehttp://hdl.handle.net/10362/148174http://purl.org/coar/access_right/c_abf2open accessCOVID-19health systemsHIVRA0421 Public health. Hygiene. Preventive MedicineQR355 VirologyHealth PolicyPublic Health, Environmental and Occupational HealthSDG 3 - Good Health and Well-beingSDG 16 - Peace, Justice and Strong InstitutionsSDG 17 - Partnerships for the Goals2113972 bytesliteraturehttp://purl.org/coar/resource_type/c_6501journal articlehttp://purl.org/coar/access_right/c_abf2application/pdffulltexthttps://run.unl.pt/bitstreams/2ee1140d-2dac-4a0c-9b4a-d0eff7b68681/download |
| spellingShingle | HIV and SARS-CoV-2 Kiekens, Anneleen COVID-19 health systems HIV RA0421 Public health. Hygiene. Preventive Medicine QR355 Virology Health Policy Public Health, Environmental and Occupational Health SDG 3 - Good Health and Well-being SDG 16 - Peace, Justice and Strong Institutions SDG 17 - Partnerships for the Goals |
| status | SINGLETON |
| subject.fl_str_mv | COVID-19 health systems HIV RA0421 Public health. Hygiene. Preventive Medicine QR355 Virology Health Policy Public Health, Environmental and Occupational Health SDG 3 - Good Health and Well-being SDG 16 - Peace, Justice and Strong Institutions SDG 17 - Partnerships for the Goals |
| title | HIV and SARS-CoV-2 |
| title_full | HIV and SARS-CoV-2 |
| title_fullStr | HIV and SARS-CoV-2 |
| title_full_unstemmed | HIV and SARS-CoV-2 |
| title_short | HIV and SARS-CoV-2 |
| title_sort | HIV and SARS-CoV-2 |
| topic | COVID-19 health systems HIV RA0421 Public health. Hygiene. Preventive Medicine QR355 Virology Health Policy Public Health, Environmental and Occupational Health SDG 3 - Good Health and Well-being SDG 16 - Peace, Justice and Strong Institutions SDG 17 - Partnerships for the Goals |
| topic_facet | COVID-19 health systems HIV RA0421 Public health. Hygiene. Preventive Medicine QR355 Virology Health Policy Public Health, Environmental and Occupational Health SDG 3 - Good Health and Well-being SDG 16 - Peace, Justice and Strong Institutions SDG 17 - Partnerships for the Goals |
| url | http://hdl.handle.net/10362/148174 |
| visible | 1 |
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