Racial, Ethnic Disparities in COVID-19 Incidence in People Living With HIV

Interested in structural racism within the healthcare industry, investigators from the University of California, San Diego examined how race and ethnicity affect COVID-19 incidence among people with HIV (PWH).

A study presented virtually at IDWeek by lead author Edward R. Cachay, MD, MAS reported the cumulative incidence and incidence rate ratios (IRR) for COVID-19 across a long-term, multi-site cohort of PWH across the US.

The investigators reviewed COVID-19 cumulative incidence and IRR among PWH inpatients from 3/1/20-12/31/20. The PWH included in the study were confirmed positive for COVID-19 and chosen from seven sites across the US within the CFAR Network of Integrated Clinical Systems (CNICS).

Among the 15780 PWH in the CNICS cohort, 62% were nonwhite with an average age of 52. 95% were on antiretroviral therapy (ART), 17% had a CD4 count below 350, and 6% had a CD4 count less than 200. COVID-19 cumulative incidence was found to be similar across CD4 cell count.

Throughout the course of the study, 651 PWH were confirmed positive for COVID-19, making the cumulative incidence 4.13%. Eventually, COVID-19 cumulative incidence increased from .77% at the end of the first quarter to 4.12% by the end of December 2020.

At the December 2020 peak, cumulative incidence in Hispanic PWH was 2.35 fold (P< .0001) higher than in white PWH, and 1.68 fold (p=.033) higher in Black PWH than white PWH. These trends remained constant despite geographic difference in pandemic wave and access to COVID-19 testing.

From their results, the investigators extrapolated that there was structural racism causing the disparity in COVID-19 incidence.

The study, “Racial and Ethnic Disparities in COVID-19 Incidence among Persons with HIV in a Multisite-Cohort,” was presented virtually at IDWeek 2021, held September 29-October 3, 2021.