Impact of the COVID-19 pandemic on outpatient follow-up among people living with HIV retained in care at a University Center in Brazil

• HIV care remained stable in patients retained during COVID-19. • Viral suppression and CD4 counts were maintained over time. • Telemedicine and ART dispensing were used during the pandemic. • Anxiety and depressive symptoms were frequently reported. • Findings reflect outcomes in a selected cohort with follow-up. To evaluate the impact of the COVID-19 pandemic on outpatient follow-up and clinical outcomes of People Living with HIV (PLHIV) at a specialized infectious diseases clinic in southeastern Brazil. A retrospective analysis was conducted using medical records and responses to a structured questionnaire from PLHIV followed between March 2020 and December 2021. Clinical and laboratory data (CD4 count, viral load, and antiretroviral therapy changes) were reviewed, and questionnaire responses were used to assess COVID-19 history, vaccination, and mental health symptoms. A total of 125 patients were included (mean age 38.6-years; 64.1% male). Prior to the pandemic, 80.3% had CD4 counts > 200 cells/µL and 82.1% had undetectable viral load, increasing to 89.7% and 84.6%, respectively, during the pandemic. Twenty-six patients (22.2%) changed their antiretroviral regimen, mainly due to switching to the nationally recommended first-line therapy. Among the 55 respondents to the questionnaire, 13 (24%) reported confirmed COVID-19 infection; of these, 2 (15.4%) required hospitalization. Overall, 53 (96.4%) reported having received the COVID-19 vaccination. Symptoms of depression and anxiety were reported by 27.7% and 45.4% of participants, respectively. Despite the logistic challenges associated with the COVID-19 pandemic, viral suppression, immunologic recovery, and retention in care remained stable in this selected cohort of patients with continuous follow-up, reflecting the resilience of the healthcare service and sustained treatment adherence.