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

A study found disproportionately higher COVID-19 cases in Black and Hispanic people with HIV across the US.


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.