COMPARATIVE ASSESSMENT OF THE NUMBER AND IMMUNOLOGICAL STATUS OF NEWLY DIAGNOSED AND RE-ENROLLED IN CARE HIV+ IN THE PERIOD 2018–2019 AND 2020-2021
Authors: Vasilev Petar , Velyanova Tanya , Baltadzhiev Ivan , Stoycheva Mariyana 
Published: December 2022

BACKGROUND: HIV infection has not been shown to be an individual risk factor, but people living with HIV and co-morbidities are at increased risk of severe COVID-19. For HIV+ individuals with severe immunosuppression and/or uncontrolled viremia, the prognosis for the course and outcome of COVID-19 remains serious. HIV infected with low CD4+ T-cell counts before antiretroviral therapy (ART) had a higher risk of complications from COVID-19 than those with higher CD4+ T-cell counts.
The aim of the study is to make a comparative assessment of the number and immunological status of newly registered and re-enrolled in care people living with HIV in the period 2018-2019 and 2020-2021 and to look for a correlation with COVID-19 pandemic  .
MATERIALS AND METHODS: The study included all people living with HIV, monitored at the Clinic of Infectious Diseases and Parasitology, “St. George” University Hospital - Plovdiv both   newly diagnosed and re-enrolled in care. Patients were divided into two groups: (1) Evaluated between  01.01.2018 and 31.12.2019 and (2) between  01.01.2020 and 15.10.2021. For the purposes of the study, methods of epidemiological and clinical analysis, ELISA, Western Blot for the diagnosis of HIV/AIDS and flow cytometry for the determination of T-cell populations were used.
RESULTS: For the period 2018-2019, there were 82 newly diagnosed and 29 re-enrolled in care HIV + patients. In 42,5% (35/82) of the newly diagnosed the number of CD4 cells was over 350 cells/ µl, in 19.5% (16/82) - between 200 and 350 cells/ µl, in 7% (6/82) - between 100 and 200 cells/ µl l and in 31% (25/82) below 100 cells/ µl. In 24% (7/29) of the re-enrolled the number of CD4 cells was above 350 cells/ µl, in 7% (2/29) - between 200 and 350 cells/ µl, in 21% (6/29) - between 100-200 cells/ µl and in 48% (14/29) - below 100 cells/ µl. For the period 2020-2021, there were 63 newly diagnosed and 34 re-enrolled in care HIV + patients. In 46% (29/63) of the newly diagnosed the number of CD4 cells was over 350 cells/ µl, in 21% (13/63) - between 200 and 350 cells/ µl, in 14% (9/63) -between 100 and 200 cells/ µl and in 19% (12/63) - below 100 cells/ µl. In 30 % (10/34) of the restarted, the number of CD4 cellswas over 350 cells/ µl, in 11% (4/34) - between 200 and 350 cells/ µl, in 15% (5/34) between 100 and 200 cells/ µl and in 44% (15/34) of patients - less than 100 cells/ µl
IN CONCLUSION: During  the period 2020-2021, 10% fewer new HIV + patients were registered as compared to the period 2018-2019. The late presenters, with CD4 <350 cells/ µl were 58% in the period 2018-2019 vs. 54% in the period 2020 -2021. The late presenters with advanced immune deficiency (CD4 <100cells / µl) were respectively 31% and 19%. The proportion of those re-enrolled in care with advanced immune deficiency (CD4 <100/ml) was 48% in the first group and 44% in the second group, respectively.  The lower number of newly diagnosed HIV + patients could be explained with the fear of   visiting  hospitals,  testing getting infected with SARS CoV-2. According to our data,   Covid-19 pandemic did not significantly affect the immune status of people living with HIV .