THE IMPACT OF THE PANDEMIC CAUSED BY COVID-19 ON THE EPIDEMIOLOGICAL STATE OF HIV INFECTION

HIV in Ukraine and raise the number of new AIDS cases and deaths. Conclusions. The pandemic caused by COVID-19 affected the provision of diagnostic, prophylactic and treatment services to HIV-infected people. There is an inversely proportional trend between the number of confirmed cases of HIV infection and cases of COVID-19. The increase in the incidence of COVID-19 occured in the autumn– winter period, which corresponded to the period of declining levels of HIV diagnosis.


INTRODUCTION/ВСТУП
HIV infection is a lentivirus anthroponotic disease with a high epidemic process level, which is becoming more widespread in all countries. The disease is characterized by the body's immune system disorders [1], long asymptomatic course and opportunistic damage of many organs and systems of the body [2][3][4].
In 2021, there were 42 million HIV-positive people in the world. Today Ukraine is one of the first countries in the European region in the number of HIV-infected [5]. 341,084 patients are officially registered in our country, the epidemic of HIV infection at the present stage is characterized by a predominant number of people of working age, one in one hundred citizens of the country aged 15 to 49 is infected with HIV [6].
In 2019, the planet was hit by a new disease -COVID-19, which was accompanied by severe respiratory syndrome caused by SARS-CoV-2. In 2020, almost a year after the dangerous virus emerged, the World Health Organization (WHO) reported that more than 76 million people were diagnosed with COVID-19, and about 1 million 700 thousand patients died from this disease [7][8][9]16].
Between 2019 and 2021, more than 6 million people worldwide were infected with SARS-CoV-2. Tough anti-epidemic measures have been introduced in many countries around the world. The COVID-19 pandemic has had a negative impact on the people with HIV. According to the WHO in July 2021, people with severe immunodeficiency who do not receive antiretroviral therapy (ART) have a particularly high susceptibility to infection and severe COVID-19 with fatal consequences [5,10].
The Global Fund to Fight AIDS, Tuberculosis and Malaria report states that COVID-19 has severely disrupted the health care system and medical services provision in the fight against HIV in low-and middle-income countries in 2020 [11].
The biggest challenge for HIV-positive patients during a pandemic is to establish continuous ART.
In accordance with the International Charitable Foundation "Public Health Alliance" («Альянс громадського здоров'я»), the COVID-19 pandemic was the social problems reason that volunteers faced during the first lockdown in the spring of 2020. It was difficult for people with HIV to obtain the necessary drugs due to restrictive quarantine measures [12,13].
The only conditions for HIV-positive people to feel safe during a pandemic are timely ART, regular laboratory tests and medical consultation in full compliance with anti-epidemic measures [12,14].
Objective. To study the impact of the COVID-19 pandemic on the current HIV epidemic and level of case registration in Ukraine.
Materials and methods. To complete the tasks, the statistical and epidemiological data of the WHO, the Ministry of Health of Ukraine and International charitable foundation "Alliance for Public Health" on the current epidemiological state of HIV infection during 2017-2021 [5,6,13,15] and Covid-19 during 2020-2021 [6,7,15] were used. For this purpose the basic complex epidemiological method including receptions of epidemiological supervision was used. Methods of comparison, statistical and logical analysis were applied to the obtained data to understand and further predict the epidemiological situation.
Statistical processing of the obtained results: all data were entered into the "Electronic research map". The following algorithms were performed: record of the fields lists for calculated data annually and/or monthly, filling in these fields, calculation, charts construction. The results of epidemiological studies were processed using the method of variation statistics using computer programs Microsoft Office Excel 2010, SPSS Statistics and online calculator (http://medstatistic/calculators/calchit.html).
Results and discussion. The epidemiological data of the WHO, Ministry of Health of Ukraine and International charitable foundation "Alliance for Public Health" on the epidemiological state of HIV infection in 2017-2021 and COVID-19 during 2020-2021 were analyzed [4,7,8,[10][11][12].
According to the Ministry of Health, as of November 1, 2021, there were 231,000 HIVpositive people in Ukraine. According to official statistics, 58 people were diagnosed with HIV every day [6],  During 2021, the number of newly diagnosed people diagnosed with HIV was 15,346 cases. 4129 people were diagnosed with terminal AIDS. The figures per 100,000 population were 36.8 and 9.9 cases, respectively. According to the above periods, retroviral infection affected: 3682, 4113, 3891, 3660 people, respectively. The AIDS stage was confirmed for 1190, 979, 1094, 866 cases, for the periods January-March, April-June, July-September, October-December, respectively (Fig. 1, 2).
During 2019-2020, 275,081 rapid tests for retroviral infection were conducted under the project of the International Charitable Foundation "Public Health Alliance". The rate per 100,000 population was 656,3 tests for antibodies to human immunodeficiency virus. 221332 tests were conducted during 2019 only, with an indicator for 525 surveys per 100 thousand Ukrainians. For the periods of January-March, April-June, July-September, and October-December 65,479, 70,945, 58,020, 26,888 diagnostics were performed, respectively.
In 2020, the Public Health Alliance in Ukraine conducted 53,749 rapid tests. The figure was 128.2 tests per 100,000 citizens. The data obtained for the above periods were 16,127,12,469,15,841,9,312 diagnostics, respectively (Fig. 3).
During 2017-2021 period, the largest number of people with the newly diagnosed HIV and AIDS was registered in 2017 -18,214 and 9,241 cases, respectively. The lowest number of patients with retroviral infection and progression to the terminal stage of the disease was recorded in 2021 and amounted to 15,346 and 4,129 cases, respectively. Data for 2018 were compared to 2017 and there were no significant differences between them. A slight decrease in indicators was observed during 2019 compared to previous years.
The number of rapid tests for retrovirus in 2019 exceeded the survey in 2020 by 4.1 times (χ2 = 8,731; χ2 at p <0.05 is 3,811). During 2019, in January-March and April-June, the largest number of tests was conducted compared to other periods of 2019 and 2020. The lowest number of surveys was conducted in April-June and October-December 2020 compared to other periods (Fig. 3).
In conclusion, with the increase in the number of COVID-19 diseases, the implementation of quarantine and general anti-epidemic measures and their strengthening, performance of rapid tests for HIV reduced. This is evidenced by an increase in the incidence of COVID-19 disease, an increase in the number of rapid tests for COVID-19 and at the same time, for the same period, a decrease in HIV testing and detection of new cases of HIV and AIDS.

CONCLUSIONS/ВИСНОВКИ
1. The potential risk of COVID-19 infection reduces the motivation of the population to be tested for HIV due to economic and psychological difficulties, especially among at-risk groups, which has led to a sharp decline in diagnostic and preventive measures against human immunodeficiency virus.
During 2020, the number of new cases of HIV infection was 1.2 times less than in 2017-2019. The number of AIDS cases for the same year was 2.1 times less than in 2017-2019 and was equal to the number in 2021. The rates of new HIV cases in 2021 were 1.24 times lower than in 2017-2020. AIDS incidence rates for the same period were equal to 2020 data.
The number of rapid tests for retrovirus in 2019 was 221,332 and exceeded the test rate (52,749 tests) in 2020 by 4.1 times.
2. Anti-epidemic measures for COVID-19 include quarantine restrictions and regular coronavirus testing. The last ones remain consistently high and, accordingly, increase annually. In 2020 and 2021, 1,055,047 and 2,612,602 cases of COVID-19 were confirmed, respectively. In 2021, the number of cases of COVID-19 increased 2.47 times compared to 2020.