Clinical Scorecard: Disparities in COVID-19 Treatment Access Related to HIV Status in the National Clinical Cohort Collaborative of the United States
At a Glance
Category
Detail
Condition
COVID-19 infection with focus on persons with HIV (PWH)
Key Mechanisms
Assessment of disparities in receipt of COVID-19 therapeutics (remdesivir, nirmatrelvir/ritonavir) by HIV status and racial/ethnic groups
Target Population
Persons with HIV and without HIV diagnosed with COVID-19 in the US
Care Setting
Outpatient and inpatient clinical settings across the US
Key Highlights
Persons with HIV had higher adjusted odds of receiving COVID-19 therapeutics compared to persons without HIV.
Significant racial and ethnic disparities exist in COVID-19 treatment receipt, with American Indian/Alaskan Native, Black/African American, and Hispanic/Latinx individuals less likely to receive remdesivir or nirmatrelvir/ritonavir compared to White Non-Hispanic individuals.
The overlapping burden of HIV and COVID-19 exacerbates health disparities, influenced by social determinants, stigma, and comorbidities.
Guideline-Based Recommendations
Diagnosis
Identify COVID-19 infection promptly in persons with and without HIV.
Recognize HIV status as a factor influencing COVID-19 severity and treatment considerations.
Management
Use remdesivir for hospitalized patients with moderate to severe COVID-19, especially those with minimal oxygen requirements.
Administer nirmatrelvir/ritonavir for mild-to-moderate COVID-19 in high-risk outpatients to reduce disease progression and hospitalization.
Consider potential drug interactions and specialized care needs in persons with HIV.
Monitoring & Follow-up
Monitor for equitable access and uptake of COVID-19 therapeutics across racial and ethnic groups.
Track treatment outcomes in persons with HIV to address disparities.
Risks
Be aware of persistent racial and ethnic inequities in treatment access that may worsen COVID-19 outcomes.
Consider comorbidities prevalent in persons with HIV that increase risk for severe COVID-19.
Patient & Prescribing Data
7,806,412 COVID-19 diagnosed patients including 45,508 persons with HIV
Persons with HIV had higher odds of receiving remdesivir (aOR 1.26) and nirmatrelvir/ritonavir (aOR 2.86) compared to persons without HIV, but racial/ethnic minorities with HIV had lower prevalence of treatment receipt compared to White Non-Hispanic individuals.
Clinical Best Practices
Ensure equitable prescription and access to COVID-19 therapeutics regardless of HIV status or race/ethnicity.
Address social determinants of health and stigma that may limit treatment uptake in persons with HIV.
Integrate HIV care with COVID-19 management to optimize outcomes in this vulnerable population.
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
