By Malik Olatunde Oduoye (Nigeria).
The COVID-19 pandemic is seriously affecting people’s lives in different ways, with more effects on people living with life peculiarities such as disabilities, HIV, and other comorbidities like diabetes, etc.
Adolescents and young adults between the ages of 15 and 30 living with HIV are a vulnerable group, with a higher loss to follow-up, virologic failure, and mortality than older adults in HIV care.
Understanding the effects of the COVID-19 pandemic on the youths living with HIV can facilitate and foster prompt and adequate interventions to support them during and after the COVID-19 pandemic.
Understanding COVID-19 & HIV
COVID-19 and HIV are both viral infections. The former is caused by the Coronavirus, an RNA Virus that belongs to the family of a virus called Coronaviridae. In contrast, the latter belongs to the lentivirus group of the retrovirus family. HIV is of two types, HIV-1 and HIV-2. HIV-1 strain occurs globally, while HIV-2 is mostly confined to West-Africa, with some spread to European Countries, such as France.
The route of transmission of COVID-19 differs from that of HIV. COVID-19 is an airborne disease. It is transmitted through air droplets, contact with infected persons via cough, sneezing, touching contaminated contact surfaces, like paper, wood, handshake.
On the other hand, HIV is transmitted through sexual intercourse, vertical transmission, that is, mother-to-child, either during childbirth (transplacental, perinatal) or during breastfeeding. Though, this is the most common route of HIV infection in children. Other modes of transmission of HIV among the youths include contaminated blood, blood products, and organ donations, and also through contaminated needles, especially with intravenous drug misuse, injections, and needle-stick injuries.
The Effects of COVID-19 on the youths living with HIV are majorly psychosocial, that is, how they perceive the pandemic disease and their pre-existing HIV disease through their daily life activities. Research has shown that adolescents and young adults living with HIV amid COVID-19 develop a depressive illness, stress disorders, adjustment disorders, manic symptoms, suicidal attempts, delusions.
The obvious reason that they are easily scared by the strangeness of the COVID-19. Most of them are on Highly active antiretroviral therapy (HAART), which are the drugs given to reduce the signs and symptoms of HIV, which ultimately reduce the victims’ mortality.
As you can see, most youths with HIV, during this pandemic period, could not get access to these drugs (HAART) due to the lock-down effect of COVID-19, which could exacerbate and worsen their clinical conditions. Most of these youths are scared to go to the healthcare facilities to receive and continue the HAART for HIV during this period.
Aside from the psychosocial effects of COVID-19 on the youths living with HIV, other clinical consequences, mostly systemic, can result. These manifestations, or consequences, including but not limited to; skin diseases, e.g., acne, scabies, papular pruritic eruptions, taeniasis (fungal infections), genital warts, etc., hematological diseases like anemia, thrombocytopenia (reduced platelet counts), lymphopenia (reduced lymphocytes counts).
Respiratory complications of HIV are mainly due to the upper airways and the lungs’ affectations, leading to an increase in both upper and lower respiratory tract infections like tuberculosis, pneumonia, bronchitis, emphysema, COPD, lung abscess, etc. Also, renal impairments can occur, manifesting as kidney failure, nephrotic syndrome, etc. The gastrointestinal effects of HIV include weight loss, diarrhea, loss of appetite, indigestion, etc.
Heart failure, endocarditis, and cardiomyopathies are some of the cardiac manifestations seen in HIV Patients. Youth with HIV can also develop eye diseases in the later stages of HIV, notably cytomegalovirus retinitis. Dementia (forgetfulness), loss of sensations in the body parts are examples of neurological effects seen in youth with HIV.
The clinical consequences and adverse effects of COVID-19 on the youths living with HIV could be lessened by;
- Psychotherapy. I strongly recommend that the youths living with HIV amid COVID-19 see a Psychiatrist and Psychologist for proper counseling, reassurance, and positive life modification of their mental health. This would help alleviate anxiety and other psychological disturbances and hope to continue adherence to the antiretroviral drugs, especially HAART.
- Provision of COVID-19 palliatives and antiretroviral drugs to HIV Patients. Governments and Non-governmental organizations, including stakeholders in health, should kindly provide COVID-19 relief packages to the youths living with HIV to increase their surviving ways and living conditions. This would also help to improve their immunities and their CD4 cells.
- Prompt HIV testing and follow-up should be made available for the youths living with HIV amid COVID-19. The test can be done either by detecting virus-specific antibodies (anti-HIV) or by directly identifying viral material. Follow up would prevent and reduce further complications of the infection.
- Discrimination among those living with HIV should be avoided. The more the discriminatory acts are shown to those living with HIV, the more the psychological effects are caused to them. Thus, we should avoid discrimination among them; rather, we should show them love, kindness, and empathy.
In a Nutshell…
The youths living with HIV amid COVID-19 are going through a lot. Their clinical syndromes could worsen due to increased fear, discrimination, reduction in treatment, testing, and follow up. We should provide adequate support, love, and care for their survival, especially during this pandemic period.
KUMAR & CLARK’S CLINICAL MEDICINE, Ed: Professor Parveen Kumar & Dr. Michael Clark. Eighth Edition (ISBN: 978-0-7020-4499-1) Pg.171-194.