Racial disparities in COVID-19 positivity among people living with HIV in the us

ABSTRACT

Background: Morbidity and mortality due to COVID-19 disproportionately impacts racial/ethnic minorities and adults with chronic diseases, potentially including people living with HIV (PLWH). Here, we present descriptive patient characteristics by COVID-19 positive and HIV status using the U.S. National COVID Cohort Collaborative (N3C). Methods: Using N3C data, we conducted a retrospective cohort analysis of patients aged ≥ 18 years that had undergone COVID-19 testing. The N3C cohort includes patients with any encounter after 1/1/2020 with SARS-CoV-2 laboratory tests or diagnostic codes. Detailed electronic medical records are centrally gathered and data harmonized across health care organizations (34 sites). COVID-19 positivity was defined by a positive RT-PCR or antibody testing . HIV infection was defined based on standard diagnostic codes within 2 years prior to COVID-19 testing. Patient characteristics by COVID-19 positive and HIV status were compared using 2 tests. Results: Over 2.1 million patients were captured in the N3C as of 11/25/2020, of whom 292,226 (13.6%) were COVID-19 positive;11,011 (0.5%) were PLWH of whom 1341 (12.2%) tested COVID-19 positive . Compared to HIV-negative patients with COVID-19, COVID-19-positive PLWH were more likely to be 45+ years of age (62.3% vs.43.8%, p<0.001), male (70% vs. 46%, p<0.001), treated on an outpatient basis (9% vs. 5%, p<0.001), and have a modified Charlson comorbidity index score ≥3 (80% vs. 10%,p<0.001). Non-Hispanic (NH) Black COVID-19 positive adults were more likely to have HIV (51% vs. 17%, p<0.001), whereas NH-White were less likely (24% vs. 47%, p<0.001) (Figure 1). When comparing to PLWH without COVID-19, PLWH with COVID-19 were less likely to have a modified Charlson comorbidity index score of 3 or above (27% vs. 32%, p<0.001), with no significant differences in age or sex. COVID-19 positive PLWH were more likely to be NH-Black (51% vs. 45%, p<0.001) and Hispanic (8% vs. 5%, p<0.001), and, conversely, less likely to be NH-White (24% vs. 36%, p<0.001 ) when compared to PLWH without COVID-19 (Figure 1). Conclusion: Racial/ethnic minorities, including NH-Black and Hispanic adults, are disproportionately affected by COVID-19 pandemic, including PLWH. Our ongoing analyses will shed light on underlying mechanisms, such as types of comorbidities, that may lead to racial/ethnic disparities in the concurrence of HIV and COVID-19 positivity in the US.