Examining a Connection Between HIV, COVID-19, and Race

It has been well-documented that racial disparities exist in the incidence rates of people diagnosed with HIV. And separately, with the emergence of the COVID-19 pandemic, the prevalence of the Non-Hispanic (NH) Black and Hispanic people being disproportionately diagnosed with the virus, and suffering higher mortality rates has also been a disturbing trend.

A new study looked at the potential conflation of HIV and COVID-19, and if there were racial disparities to be discovered within the combination of these two health issues.

Jessica Islam PhD, MPH, assistant member of Cancer Epidemiology at Moffitt Cancer Center, was part of a team of investigators who looked at racial disparities of COVID-19 in people living with HIV (PLWH) in the United States. They reviewed COVID-19 positive data and HIV status by using the US National COVID Cohort Collaborative (N3C).

“We were able to look specifically into people living with HIV and racial disparities in COVID-19 positivity across racial and ethnic groups,” Islam stated.

As an epidemiologist, Islam’s previous research has focused on the prevention of cancers caused by infection, and treatment outcomes and disparities among PLWH.

Within the N3C, over 2.1 million patients were captured by the end of November 2020. Of those included in this cohort, 292,226 had been diagnosed with COVID-19, 11,011 people living with HIV (PLWH) and of them 1341 had tested positive for COVID-19.

As part of their comparison, Islam et al looked at HIV-negative patients with COVID-19 and also PLWH who had COVID-19. The investigators found the latter cohort 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). They also had a modified Charlson comorbidity index score ≥3 (80% vs. 10%,p<0.001).

The investigators also found that Non-Hispanic Blacks who had COVID-19 were more likely to have HIV (51% vs. 17%, p<0.001), as opposed to NH Whites who were less likely (24% vs. 47%, p<0.001).

“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,” the investigators reported.

“Certainly, racial disparities persist among people living with HIV and COVID-19 positivity, even after we adjusted for covariates such as age, sex, and comorbidity index…after we adjusted for all those cofactors, which could explain these disparities, we continued to see that Non-Hispanic Black, Hispanic and Asian people living with HIV have higher odds of COVID-19 positivity when compared to Non-Hispanic White adults.”

Part of the issue Islam says is the existing structural barriers in place for minorities that make it more difficult to adhere completely to preventative behaviors when it comes to COVID-19.

Contagion spoke to Islam recently about the importance of the N3C data base, further insights into this study, as well as her other research looking at structural barriers as it relates to preventative behaviors related to COVID-19.