Disparities in COVID-19 Treatment Access by HIV Status in US National Cohort
Overview
This study analyzed over 7.8 million COVID-19 cases, including 45,508 persons with HIV (PWH), to assess disparities in receipt of COVID-19 therapeutics. Persons with HIV had higher odds of receiving remdesivir and nirmatrelvir/ritonavir compared to those without HIV, yet significant racial and ethnic inequities in treatment access persisted.
Background
The COVID-19 pandemic disproportionately affected vulnerable populations, including racial and ethnic minorities and immunosuppressed individuals such as persons with HIV. PWH often have higher prevalence of comorbidities that increase COVID-19 severity risk. Despite the availability of effective therapeutics like remdesivir and nirmatrelvir/ritonavir, disparities in access to these treatments have been documented in the general population, but data on PWH remain limited. Understanding how HIV status intersects with sociodemographic factors to influence COVID-19 treatment access is critical to addressing health inequities.
Data Highlights
Characteristic
Adjusted Odds Ratio (aOR) for Therapeutic Receipt
95% Confidence Interval
Remdesivir receipt in PWH vs PWoH
1.26
1.20 - 1.33
Nirmatrelvir/ritonavir receipt in PWH vs PWoH
2.86
2.77 - 2.95
Lower remdesivir receipt among American Indian/Alaskan Native PWH vs White Non-Hispanic
Coefficient 0.997
Not specified
Lower remdesivir receipt among Hispanic/Latinx PWH vs White Non-Hispanic
Coefficient 0.992
Not specified
Lower nirmatrelvir/ritonavir receipt among Black/African American PWH vs White
Coefficient 0.947
Not specified
Lower nirmatrelvir/ritonavir receipt among Black/African American PWoH vs White
Coefficient 0.943
Not specified
Lower nirmatrelvir/ritonavir receipt among American Indian/Alaskan Native PWH vs White
Coefficient 0.996
Not specified
Lower nirmatrelvir/ritonavir receipt among Hispanic/Latinx individuals vs White
Coefficient 0.992
Not specified
Key Findings
Persons with HIV had significantly higher adjusted odds of receiving remdesivir (aOR 1.26) and nirmatrelvir/ritonavir (aOR 2.86) compared to persons without HIV.
Despite higher overall treatment receipt among PWH, racial and ethnic disparities persisted in access to COVID-19 therapeutics.
American Indian/Alaskan Native and Hispanic/Latinx persons with HIV had lower estimated prevalence of remdesivir receipt compared to White Non-Hispanic individuals.
Black/African American persons with and without HIV had lower estimated prevalence of nirmatrelvir/ritonavir receipt compared to White counterparts.
Structural and systemic barriers contribute to persistent inequities in COVID-19 treatment access among racial and ethnic minorities, including those with HIV.
Clinical Implications
Clinicians should be aware that despite higher overall COVID-19 therapeutic use among persons with HIV, significant racial and ethnic disparities in treatment access remain. Efforts to ensure equitable prescription and receipt of effective COVID-19 treatments, particularly among minority populations with HIV, are essential to reduce adverse outcomes. Addressing systemic barriers and social determinants of health is critical to improving equitable care delivery.
Conclusion
Persons with HIV are more likely to receive COVID-19 therapeutics than those without HIV; however, persistent racial and ethnic disparities in treatment access highlight ongoing inequities that require targeted interventions to ensure equitable healthcare delivery.
References
National Clinical Cohort Collaborative (N3C) Study 2024 -- Disparities in COVID-19 Treatment Access Related to HIV Status
by Emmanuel Nazaire Essam Nkodo, Pooja Maheria, Eric Hurwitz, Alfred Jerrod Anzalone, Dongmei Li, Jessica Y Islam, Jing Sun, Cara D Varley, Zachary Butzin-Dozier, Sandra E Safo, Kaylyn Kirksey, Shukri A Hassan, Marlene Camacho-Rivera, Rena C Patel, Nada Fadul, On behalf of the National Clinical Cohort Collaborative USA
