Background Long‐COVID is emerging as a significant problem among individuals who recovered from COVID‐19. Scant information is available on the prevalence, characteristics, and risk factors for long‐COVID among people living with HIV (PLHIV). Setting A tertiary level, private, HIV clinic in western India. Methods A prospective, observational study was conducted to assess the prevalence of long‐COVID among PLHIV. Long‐COVID was defined as the presence of at least one symptom after 30 days of illness onset. A questionnaire for assessing general, cardiorespiratory, neuro‐psychiatric, and gastro‐intestinal symptoms was used to screen individuals with history of confirmed COVID‐19. Data on demographics, HIV‐related variables, comorbidities, and severity of COVID‐19 were abstracted from electronic medical records. Univariate and multivariate logistic regression were used to identify risk factors for long‐COVID. Results Ninety‐four PLHIV were screened for long‐COVID. Median (interquartile range [IQR]) age was 51 (47–56) years and 73.4% were males. The majority (76.6%) had a history of asymptomatic–mild COVID‐19 illness. The prevalence of long‐COVID was 43.6% (95% confidence interval [CI], 33.4–54.2). Moderate–severe COVID‐19 illness was significantly associated with long‐COVID (adjusted odds ratio, 4.7; 95% CI, 1.4–17.9; p = .016). Among individuals with long‐COVID, cough (22.3%) and fatigue (19.1%) were the commonest symptoms. The median (IQR) duration for resolution of symptoms was 15 (7–30) days. Ten individuals (10.6%) had persistent symptoms at a median of 109 days since the onset of COVID‐19. Conclusion Long‐COVID is common among PLHIV with moderate–severe acute COVID‐19 illness. There is a need for integration of long‐COVID diagnosis and care services within antiretroviral therapy clinics for PLHIV with COVID‐19.

Background Most studies assessing drug resistant tuberculosis (DRTB) in human immunodeficiency virus (HIV) co-infected patients in India have used conventional culture- based systems to diagnose DRTB that have a longer turnaround time leading to risk of amplification of resistance to an empirical regimen. We determined the prevalence of DRTB amongst people living with HIV (PLHIV) using the line probe assay and determined risk factors associated with the presence of multi drug resistant tuberculosis (MDRTB). Methods A Cross-sectional study was undertaken at Poona Hospital and Research Center (PHRC) and the Institute of Infectious Diseases, two tertiary level private care centers in Pune, India. Consenting PLHIV with confirmed Pulmonary TB (PTB) and/or extra-pulmonary TB (EPTB) diagnosed based on detection of Mycobacterium TB by line probe assay (Geno Type MTBDRplus version 2) on clinical specimens were included. Those with documented past history of DRTB were excluded. Resistance against anti-TB drugs was determined by the same assay. The prevalence of any form of drug resistant TB (DRTB), MDRTB, Rifampicin resistant TB (RRTB) and Isoniazid (INH) mono-resistant TB were determined as the proportion of these amongst all included PLHIV-TB. A multivariate analysis was conducted to determine risk factors that were statistically associated with MDRTB, DRTB, RRTB and INH mono-resistant TB. Results Two hundred PLHIV were recruited. The prevalence (95% CI) of MDRTB, INH mono- resistance and RR resistance was 12.5% (7.9–17.1%), 9% (6.9–11.2%) and 2.5% (1.4–3.6%), respectively. The prevalence (95% CI) of MDRTB among new and relapsed patients was 8.8% (6.5–11.1%) and 23.1% (17.2–28.9%), respectively. Tuberculosis relapse was the only factor significantly associated with MDRTB, DRTB and INH mono-resistant TB. Conclusion We document a high prevalence of drug resistance to anti-TB drugs including MDRTB among PLHIV in our setting using Geno Type MTBDRplus directly on clinical specimens. This validates the WHO recommendation of performing routine rapid molecular resistance testing prior to initiating anti-TB treatment among all PLHIV with presumptive TB. Using rapid molecular testing especially Geno Type MTBDRplus (that detects resistance to INH and Rifampicin simultaneously) reduces the turn-around time helping in optimizing treatment.

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A retrospective cohort study was conducted to assess clinical characteristics and outcomes of coronavirus disease-19 (COVID-19) among people living with HIV (PLHIV) in western India. Out of 86 PLHIV with COVID-19 illness, 19.7% had severe/critical illness and 6 (6.9%) individuals died. Median (interquartile range) age was 51 (47-56) years and 77.6% were male. Eighty-five PLHIV were on antiretroviral treatment with 98% having a viral load <200 copies/mL. Hypertension (HTN) (38.3%) and diabetes mellitus (17.4%) were commonest comorbidities. Fifty-eight percent PLHIV were hospitalized while 6.9% individuals needed intensive care. Presence of medical comorbidity was significantly associated with severe/critical COVID-19, whereas HTN was significantly associated with mortality. Recovery from COVID-19 was documented in 93% PLHIV. In conclusion, PLHIV in western India have similar COVID-19 clinical outcomes as compared with those reported historically among general population. Presence of medical comorbidities rather than HIV-related disease characteristics is associated with severe COVID-19 illness.

Background Data on the use of dolutegravir for treatment of HIV-2 infection are limited. Objectives To assess the effectiveness of dolutegravir in people living with HIV-2 (PLHIV-2). Methods A retrospective chart review was performed in two clinics in Western India. PLHIV-2 initiated on dolutegravir-based regimens were included. Response to treatment in both treatment-naive (TN) and treatment-experienced (TE; substitution and not in the context of failure) was assessed by CD4 counts and HIV-2 viral load (VL) in a proportion of individuals. The primary objective was to assess immunological effectiveness (absence of a drop in absolute CD4 counts by more than 30% of baseline). Change in absolute CD4 counts was assessed by fitting a mixed-effects model. Results Sixty-two PLHIV-2 treated with dolutegravir were included. The immunological effectiveness rates (95% CI) were 91.9% (82.4%–96.5%), 92% (81.1%–96.8%) and 91.6% (64.6%–98.5%) amongst all, TE and TN individuals, respectively. Median change in absolute CD4 counts at 6, 12 and 18 months were +29 cells/mm3, +101 cells/mm3 and +72 cells/mm3, respectively. The virological effectiveness rates (HIV-2 VL &lt;100 copies/mL) (95% CI) for all, TE and TN individuals were 88.8% (74.6%–95%), 89.6% (73.6%–96.4%) and 85.7% (48.6%–97.4%), respectively. Three clinical events were documented: spinal tuberculosis, relapsed non-Hodgkin’s lymphoma and herpes simplex virus retinitis. One individual reported self-limiting somnolence. Conclusions Dolutegravir was well tolerated and associated with immunological, virological and clinical effectiveness in both TN and TE PLHIV-2 in a large cohort from Western India. Dolutegravir-based ART is an excellent option for treatment of individuals with HIV-2 infection.

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Background In multi-site HIV observational cohorts, clustering of observations often occur within sites. Ignoring clustering may lead to “Simpson's paradox” (SP) where the trend observed in the aggregated data is reversed when the groups are separated. This study aimed to investigate the SP in an Asian HIV cohort and the effects of site-level adjustment through various Cox-regression models. Methods Survival time from combination antiretroviral therapy (cART) initiation was analysed using four Cox models: (i) no site adjustment; (ii) site as a fixed effect; (iii) stratification through site; and (iv) shared frailty on site. Results A total of 6454 patients were included from 23 sites in Asia. SP was evident in the year of cART initiation variable. Model (i) shows the hazard ratio (HR) for years 2010-2014 was higher than the HR for 2006-2009, compared to 2003-2005 (HR = 0.68 vs 0.61). Models (ii)-(iv) consistently implied greater improvement in survival for those who initiated in 2010-2014 than 2006-2009 contrasting findings from Model (i). The effects of other significant covariates on survival were similar across four models. Conclusions Ignoring site can lead to SP causing reversal of treatment effects. Greater emphasis should be made to include site in survival models when possible.

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