HIV patients live with a chronic, potentially deadly disease, and COVID-19 has only made their lives more difficult. In addition to adding a health threat, the coronavirus has isolated people and stripped them of their livelihoods, with potentially tragic physical and mental health consequences.
This is an important issue in South Florida. There are more than 26,000 people living with HIV in Miami-Dade County, and the region has the highest rate of new cases in the nation. To understand these new dynamics, researchers at the University of Miami Miller School of Medicine are studying the impact the coronavirus is having on this vulnerable population and the best ways to help them.
“For those of us working with people living with HIV, and for those of us who are clinicians, the main question has been: How does this coronavirus affect people with an impaired immune system?” said Maria Luisa Alcaide, M.D., professor of clinical medicine and director of the Infectious Disease Research Unit. Dr. Alcaide is working with long-time collaborator Deborah Jones Weiss, Ph.D., professor of psychiatry and behavioral sciences and co-director of the Center for HIV and Research in Mental Health (CHARM).
The two have collaborated for many years, locally and internationally, to paint a more comprehensive picture of the mental and physical impacts HIV has on patients. But COVID-19 presents a new set of challenges, and they are working with several multidisciplinary teams to better understand its effects and meet patients’ needs.
Dr. Weiss has started enrolling patients in a study titled Weathering the Storm, which will examine HIV patients’ mental health in response to the pandemic. Dr. Alcaide is heading a study on the health impacts of the coronavirus on HIV patients. Drs. Alcaide and Weiss, along with professor of medicine and nationally renowned infectious diseases expert and researcher Margaret Fischl, M.D., are leading a multi-site study examining COVID and HIV.
The good news, so far, is there’s no evidence COVID-19 has affected HIV patients’ physical health more than other populations. Still, this early research does not speak to long-term impacts, and even the perception of danger can increase risk.
“We heard quickly that people had a sense of being at risk more than the general population,” Dr. Weiss said. “For many years, people with HIV have begun to feel safe. They have effective medications and can live a normal life, and suddenly COVID appears, and they are experiencing the same sort of anxiety they had early in the HIV epidemic.”
Dr. Weiss noted that anxiety can lead to depression. Many are feeling the loss of physical contact with family and friends. This isolation can seem painfully similar to the stigmatization the HIV community experienced years earlier.
Dr. Alcaide and Dr. Weiss are currently studying how these emotional challenges can impact physical health, and are particular concerned that depressed patients may not fully comply with their treatment regimens.
“We know that if they stop taking their medications, whether that's because they lose their insurance, cannot make it to the doctor or for any other reason, it will have a negative result in their HIV as they will have uncontrolled viral load,” said Dr. Alcaide. “If their HIV medications are stopped, it’s almost like having a new infection, it's associated with persistence and other comorbidities because the immune system has to respond to a virus that has been suppressed for a while.”
The team is also working closely with Isabel Cassetti, medical director of Helios Salud, Ambulatory AIDS Care Center in Buenos Aires, and other researchers in Argentina to study how patients are responding to the many stresses associated with COVID-19.
“Resilience is the ability to deal with a crisis state and return to a normal state quickly rather than becoming overwhelmed,” said Dr. Weiss. “We're finding that when people are experiencing financial stressors – they don't have enough money to pay for food or the basic necessities – if they have the characteristics of resilience, they're less likely to become depressed and less likely to have negative mental health outcomes.”
University of Miami clinics are offering telehealth to all patients to meet their medical needs. Following a phone or video visit, doctors send the medications and laboratory orders electronically. Pharmacy, case management and social worker services are also being conducted remotely.
In addition, clinicians strongly encourage HIV patients to continue taking their medications and comply with all COVID-19 prevention strategies.
“It's extremely important they adhere to the precautions that everybody knows and everybody should be doing,” said Dr. Alcaide. “It's physical distancing, hand washing, avoiding being in crowded spaces and wearing masks or other facial coverings.”