National impact of SARS-CoV-2 infection on HIV virological suppression in South Africa.

Abstract

Coronavirus disease (COVID-19) severely disrupted routine healthcare globally. This study assessed the impact of successive COVID-19 waves on HIV viral load (VL) suppression in South Africa, using the national public sector laboratory database. Guidelines recommend VL monitoring at 6 months after treatment initiation, and annually once suppressed, or more frequently if unsuppressed. Specimen-level VL data was extracted for the period January 2019 to December 2021. We assessed the national percentage of samples with a VL <50 (virological suppression), 50-999 (low-level viremia) and ≥1000 (viraemia) copies/mL. Data was analysed by calendar year and month. Data for 2019 (pre-COVID-19) was compared to the 2020 and 2021 calendar years (lockdowns imposed). The national number of COVID-19 cases was reported to indicate the wave periods as follows: one (ancestral)-June to August 2020; two (Beta)-December 2020 to January 2021; three (Delta)-June to August 2021 and four (Omicron)-December 2021. Data is reported for 17,460,264 samples, with 5,608,733, 5,840,056 and 6,011,475 tests performed in 2019, 2020 and 2021 respectively. Overall, a VL of <50, 50-999 and ≥1000 copies/mL were reported for 69.4%, 17.3% and 13.4% of samples. A VL <50 copies/mL was reported for 67.7%, 70.3% and 70.0% of patients in 2019, 2020 and 2021 respectively. For the 2020 and 2021 calendar years, the monthly percentage of patients with a VL <50 copies/mL ranged between 64.6% to 72.7%. Our findings indicate that Covid-19 has not had a substantial impact on the percentage of samples with virological suppression at the national level.