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Advanced HIV probably missed due to lockdown in South Africa


Surveillance should be ramped up or HIV deaths could spike, scientists warn

Laboratory tests for cryptococcal meningitis, a common HIV-related cause of death, dropped in South Africa during the country’s coronavirus lockdown. This means that cases are likely being missed, which raises concern about a spike in illness in months to come, scientists warn.

The National Institute of Communicable Diseases in Johannesburg routinely screens blood samples collected through the public health system with CD4 counts below 100 for Cryptococcal antigen (CrAg), a biomarker for cryptococcal disease which can be detected weeks or months before symptoms appear. 

But according to data published by the NICD in a 15 June report, the number of CrAg tests dropped from a weekly of 5,613 before the lockdown began to around 4,500 during lockdown. At the same time, the proportion of CrAg tests coming out positive increased, meaning cases were probably being missed. 

NICD scientists speculate that the drop was the result of a number of factors, from lockdown making getting to the clinic difficult, to reluctance seeking healthcare due to a fear of contracting Covid-19. “These factors may have especially influenced individuals with mild or no symptoms of advanced [HIV] disease and cryptococcal disease or other opportunistic infections to delay or entirely avoid care seeking,” the scientists say in their report. 

Given the concern that cases have been missed, doctors should be wary of a spike in cryptococcal meningitis and advanced HIV disease in the coming months, the scientists say.

The lockdown has also resulted in a reduction in the number of tests carried out for tuberculosis in South Africa. This has raised concern not only that fewer people are starting TB treatment who need it, but also that undiagnosed TB cases that are likely to spread the disease are proliferating, which could fuel a rise in that disease as well.