Stephen Rawlings, MD, PhD Clinical Fellow Division of Infectious Diseases & Global Public Health Department of Medicine University of California, San Diego

1. HIV & Global Health Rounds
The UC San Diego AntiViral Research Center sponsors weekly
presentations by infectious disease and global public health
clinicians, physicians, and researchers. The goal of these
presentations is to provide the most current research, clinical
practices, and trends in HIV, HBV, HCV, TB, and other
infectious diseases of global significance.
The slides from the HIV & Global Health Rounds presentation
that you are about to view are intended for the educational
purposes of our audience. They may not be used for other
purposes without the presenter’s express permission.

2. COVID-19 and HIV: What We
Know & Efforts to Answer
What We Don’t Know
HIGH Rounds – 4.3.2020
Stephen A Rawlings, MD PhD
Pronouns: he, his, him
Infectious Diseases Fellow
UC San Diego Health

3. Disclosures
• No disclosures

4. Good sources of information
• Dr. Schooley’s Grand Rounds (March 18, 2020)
• COVID talk at CROI 2020 (March 10, 2020)
• Several talks by experts with useful facts about the
evolution of the virus and state of the epidemic in China
• https://covid-19.uwmedicine.org
• CID/Oxford articles
(https://academic.oup.com/journals/pages/coronavirus?)
• https://aahivm.org/covid-resources/
• Social media
• Twitter: @CarlosdelRio7, @DrMattMcCarthy
• @Darcy_ID_doc

5. Good sources of information
• Harm Reduction has some nice literature about
safer drug use during COVID:
• https://harmreduction.org/wp-content/uploads/2020/03/COVID19-
safer-drug-use-1.pdf

6. Jason E. Farley, PhD, MPH, ANP-BC, FAAN, AACRN
Professor & Nurse Practitioner
Johns Hopkins University School of Nursing and Medicine

7. The Impact of COVID on HIV Patient Care – we
need data
COVID
19
Viral
Suppression
Mental
Health
Substance
Use
Patient
Centered
Home
Vulnerability
1. Stigma
2. Isolation
3. Morbidity
4. Violence
1. Loss of support system
2. Changing models of
MAT centers
3. Relapse?
1. Virtual care delivery for
PrEP / HIV treatment
2. What about supportive
services?
1. Poverty increases
vulnerability
2. Housing instability
3. Economic instability
1. Viral suppression is labile in
some patients
2. What virtual strategies
increase adherence?
Jason E. Farley, PhD, MPH, ANP-BC, FAAN, AACRN
Professor & Nurse Practitioner
Johns Hopkins University School of Nursing and Medicine

8. The Virtual Patient Centered Medical Home:
The New Normal after COVID19?
Jason E. Farley, PhD, MPH, ANP-BC, FAAN, AACRN
Professor & Nurse Practitioner
Johns Hopkins University School of Nursing and Medicine

9. High Risk Groups
• Within the next few years more than half of the
people living with HIV in the US will be over 50 yrs
(The HIV and Aging Consensus Project.) Abrass, Christine K., et al.)
• Multimorbidity syndrome is increasing in the
Aging HIV populations i.e heart disease, diabetes,
smoking, alcohol)
(Greene 2013 : Greene 2015; Singh 2017: Greene 2017)
• “HIV disproportionally affects the most vulnerable
in society”
(Policy position statement. American Academy of HIV Medicine)
COVID-19-Vulberable Groups
World Health Organization
Cleophas d’AuvergneMD. MPA (Dip TB WHO/USAID) AAHIVS

13. Update on Clinical Trials at UCSD
Study Leads Status
Remdesivir: Adaptive COVID-19 Treatment
Trial Multicenter: NCT0428075
Daniel Sweeney (Co-PI)
Connie Benson (Co-PI)
Enrolling
Tocilizumab in COVID-19 Pneumonia
(TOCOVID-19) Multicenter: NCT04317092
Atul Malholtra (PI, Pulm)
Aaron Carlin (Co-I, ID) Bob
Owens (Co-I, Pulm)
Connie Benson (Co-I, ID)
Pending
(starting
Friday?)
Hydroxychloroquine for Hospitalized Patients
with Covid-19 UCSD
Cathy Logan (PI)
Lucy Horton (Co-I)
Davey Smith, Susan Little
Doug Richman
John Guatelli, Sam Penziner
Scott Johns, Nina Haste
Pending
(starting next
week)
Hydroxychloroquine/azithromycin for
Ambulatory Patients with Covid-19 NIH/ACTG
Davey Smith
Connie Benson, Susan Little
COVID-19 Convalescent serum protocols Lalo Cachay (PI)
Chip Schooley
Information to be available on Division Website

14. Update on COVID-19 Research at UCSD
Study Leads
Multiple studies for new diagnostic platforms Davey Smith
Stephen Rawlings
CoV in genital secretions Davey Smith
Stephen Rawlings
Developing guidance for donor screening, recipient management etc
related to COVID-19
Saima Aslam
Collecting info on transplant recipients with COVID-19 Saima Aslam
COVID-19 in transplant patients Saima Aslam
Development of monoclonal antibodies from infected patients Tom Rogers
Stephen Rawlings
Molecular epidemiology studies Antoine Chaillon
Epidemiology study being formulated with new diagnostics in Tb
cohort (and maybe others)
Timothy Rodwell
Epidemiology study from Good to Go with new diagnostics Susan Little
Information to be available on Division Website

15. Update on COVID-19 Research at UCSD
Study Leads
Development of vaccine protocols Davey Smith, Susan Little
w/various companies
Understand T cell and B cell immune responses. Aaron Carlin
Tom Rogers
Alexander Sette
Invasive Aspergillus during COVID-19 Martin Hoenigl
Coordinating VA response/trials Mike Oxman
Registry & Repository Eliah Aronoff-Spencer (PI)
Theo Kirkland, Katya Prakash
Stephen Rawlings
Jeff Jenks, Martin Hoenigl
Extension of Last Gift Study Davey Smith et al
Covid-19 in Patients with HIV, National CNICs
coordination: Epidemiology, Symptoms, Immunology
Lalo Cachay
Information to be available on Division Website

16. Update on COVID-19 Research at UCSD/VA
Study Leads
Study to Evaluate the Safety and Antiviral Activity of
Remdesivir (GS-5734™) in Participants with
Moderate Coronavirus Disease (COVID-19)
Compared to Standard Care Treatment
NCT04292730
John Guatelli
Sanjay Mehta
Mary Lewinski
Study to Evaluate the Safety and Antiviral Activity of
Remdesivir (GS-5734™) in Participants with Severe
Coronavirus Disease (COVID-19)
NCT04292899
John Guatelli
Sanjay Mehta
Mary Lewinski
Re-purposed anti-malarial drugs and novel anti-
malarial compounds for use in COVID-19 prophylaxis
and treatment
Pre-clinical
Elizabeth Winzeler
Tom Rogers
Clinical Trials
Digital Clinical Trials Group
Sara Browne
Constance Benson
Florin Vaida
A Proposal for the Production and Distribution of
COVID-19 Convalescent Plasma and Immune
Globulin in the U.S.
Mike Oxman
John Zaia
Information to be available on Division Website

17. Dr. Cachay et al.
“Impact of COVID-19 among PWHIV in the CNICS Cohort:
Symptomatic incidence, predictors of disease severity,
asymptomatic seroconversion, and immune patterns
characterization.”
• Some key questions, we hope to address:
• Is COVID-19 more severe than the general
population? Symptomatic incidence. Case fatality.
• What are the predictors of disease severity among PWHIV?
• Do they have less frequent asymptomatic seroconversion?
• Among those PWHIV who developed the symptomatic
disease, do we know how long will immunity
last? Implications for curving the ongoing epidemic
• Using a hopefully nation-data set, we will see if the use of
ACE-I affects any of the proposed outcomes.

19. UCSD PWH
• CoV-2 tests (courtesy of Dr. Wooten):
• 74 negative
• 18 positive (19.5% of all PWH tests!)
• 4 pending
• At one point, 3 PWH had COVID and in ICU
• One patient in 30’s on vent
• No deaths
• Darcy Wooten, Lalo Cachay, and others maintaining
registry of PWH who are COVID+/PUI at UCSD

21. Positive Cases in San Diego County Since February 14, 2020
Table updated March 31, 2020, with data through April 2, 2020.
COVID-19 Case Summary San Diego County Residents
Total Positives 966
Age Groups
0-9 years 8 1%
10-19 years 9 1%
20-29 years 187 19%
30-39 years 216 22%
40-49 years 170 18%
50-59 years 149 15%
60-69 years 108 11%
70-79 years 71 7%
80+ years 45 5%
Age Unknown 3 0%
Gender
Female 439 45%
Male 514 53%
Unknown 13 1%
Hospitalizations 181
Intensive Care 70
Deaths 16

22. A moment of levity

23. Thank you!