중남미

Human immunodeficiency virus (HIV) remains a significant global public health problem, with approximately 39 million people living with HIV (PLHIV) and 630,000 acquired immunodeficiency syndrome (AIDS)-related deaths in 2022 [1]. The introduction of antiretroviral therapy (ART) has been a game-changer in the fight against HIV. Highly effective drugs with improved pharmacokinetics and tolerability have enhanced the prognosis and quality of life for PLHIV, contributing to a 68.5% decline in AIDS-related deaths worldwide between 2004 and 2022 [1]. Since 2018, the World Health Organization (WHO) has recommended dolutegravir-based regimens as first- and second-line treatments for all PLHIV due to their high efficacy and favorable toxicity profile [3]. However, the use of these regimens has been primarily limited to high-income countries [4]. Venezuela has experienced the highest rate of ART interruptions among Latin American countries since 2016, with the situation worsening in 2017 and 2018 due to limited access to ART, with only 16% of patients receiving treatment by April 2018 [5]. However, through the efforts of nongovernmental organizations and the implementation of the Master Plan for the Strengthening of the Response to HIV, Tuberculosis, and Malaria in Venezuela [6], nationwide access to dolutegravir-based ART was resumed in February 2019. Despite this progress, monitoring of the efficacy and tolerability of this regimen in both treatment-experienced and newly diagnosed patients has been limited. Strict adherence to ART is crucial for maintaining an undetectable viral load, reducing the risk of progression to AIDS and transmission of HIV to sexual partners [7]. However, epidemiological surveillance related to access to diagnosis, treatment, and viral suppression remains limited in Venezuela. The coronavirus disease 2019 (COVID-19) pandemic has had significant direct and indirect impacts on global health, particularly in low- and middle-income countries [8, 9], including Venezuela, where the effects are compounded by a complex humanitarian crisis, weakened health systems, and concurrent epidemics such as HIV, malaria, and tuberculosis [5]. In some countries, the COVID-19 pandemic has disrupted HIV testing, care [9,10,11], and treatment [12] services, potentially leading to increased HIV-related deaths and transmission, and jeopardizing progress towards the Joint United Nations Programme on HIV/AIDS 90-90-90 global target [13]. Moreover, despite that several studies showing that COVID-19 vaccination is effective in preventing these adverse outcomes [14,15,16,17], vaccine hesitancy remains a global problem [18], particularly among higher-risk populations such as PLHIV. Concerns about vaccine safety have been identified as a primary factor contributing to COVID-19 vaccine hesitancy among this population [19, 20]. Currently, there is limited information available on the impact of the COVID-19 pandemic on PLHIV in Venezuela. Additionally, the rate of COVID-19 vaccine hesitancy among this population is unknown. This study aims to assess the impact of the COVID-19 pandemic and COVID-19 vaccine hesitancy among PLHIV seen at the outpatient clinic of the Infectious Diseases Department at the University Hospital of Caracas during the period of the COVID-19 pandemic in Venezuela.