HIV and Long COVID Insights from the RECOVER Program on Risk and Diagnosis

At CROI 2025, held March 9-12, in San Francisco, California, Kellie Hawkins, MD, assistant professor of medicine at the University of Colorado and attending infectious disease physician at Denver Health, discussed findings from the RECOVER Program, which explores the impact of HIV on Long COVID. The study examined the incidence of Long COVID in people living with HIV (PWH) and aimed to understand the association between HIV infection and Long COVID symptoms.

Hawkins explained diagnosing Long COVID, "What we really need is a biomarker or a lab that could help us in the diagnosis. And recent studies have looked for that and have not found it. So right now, what we have are clinical algorithms, essentially," she said. These clinical frameworks use symptoms to define Long COVID but may not be fully effective in populations with chronic conditions like HIV.

The study analyzed data from the Patient-Centered Clinical Research Network (PCORnet) and the National Clinical Cohort Collaborative (N3C). It found that people with HIV had a slightly increased risk of developing Long COVID. In the PCORnet cohort, the odds ratio (OR) for Long COVID in PWH was 1.09, and in N3C, it was 1.18. However, no significant association was observed when using ICD-10 diagnostic codes.

Hawkins noted that Long COVID was more frequently diagnosed using symptom-based phenotypes than ICD-10 codes, suggesting that Long COVID may be under-recognized in PWH. "Long COVID may be under-recognized and under-diagnosed in people with HIV, particularly due to the overlap of symptoms with baseline chronic conditions," she said.

The study also highlighted that people with HIV were more likely to be younger, male, and identify as Black or Hispanic, with higher pre-pandemic healthcare utilization. These factors may influence how Long COVID is identified and diagnosed in clinical settings.

Hawkins emphasized the importance of distinguishing between symptoms that existed before a COVID diagnosis and those that are new, "It’s especially important when we're thinking about clinical diagnosis to keep in mind that we may need to think about whether or not certain conditions were present before a COVID diagnosis, or are they new symptoms," she said.

The study also pointed out that important factors like vaccination status and repeat infections were not included in the analysis. Hawkins explained, "We know that vaccination is likely protective against Long COVID while repeated infection is a risk factor for Long COVID development. Depending on the groups, it’s very possible that people with HIV are vaccinated more against COVID, and that could alter our findings."

Addressing disparities in care for people with HIV and Long COVID, Hawkins suggested strategies, "Education of providers and people in the healthcare field to know Long COVID, know how to diagnose it, and feel comfortable talking about it with patients, and then also education of patients and people who might be suffering from Long COVID, so that they can recognize their own symptoms," she said.

Reflecting on the importance of conferences like CROI, Hawkins noted, "CROI is such a world-class event, and it really allows your research to be amplified and to be viewed by such a large audience of engaged thinkers, from researchers to clinicians to patients. It brings together a community that can advance discussions and the research."

Reference

Hawkins K, et al. HIV Infection and Long COVID: A RECOVER Program, Electronic Health Record-Based Cohort. Poster #918 presented at CROI 2025. March 9-12, 2025, San Francisco, California.