HIV outcomes during the COVID-19 pandemic in people of Black ethnicities living with HIV in England

Zoe Ottaway; Lucy Campbell; Julie Fox; Fiona Burns; Lisa Hamzah; Stephen Kegg; Melanie Rosenvinge; Sarah Schoeman; David Price; Rachael Jones; Robert F Miller; Shema Tariq; Frank A Post

doi:10.1111/hiv.13640

HIV outcomes during the COVID-19 pandemic in people of Black ethnicities living with HIV in England

HIV Med. 2024 Mar 26. doi: 10.1111/hiv.13640. Online ahead of print.

Authors

Zoe Ottaway^{1

2}, Lucy Campbell^{1

2}, Julie Fox^{2

3}, Fiona Burns^{4

5}, Lisa Hamzah⁶, Stephen Kegg⁷, Melanie Rosenvinge⁷, Sarah Schoeman⁸, David Price⁹, Rachael Jones¹⁰, Robert F Miller^{5

11}, Shema Tariq^{5

11}, Frank A Post^{1

2}

Affiliations

¹ King's College Hospital NHS Foundation Trust, London, UK.
² King's College London, London, UK.
³ Guys and St Thomas's NHS Foundation Trust, London, UK.
⁴ Royal Free London NHS Foundation Trust, London, UK.
⁵ Institute for Global Health, University College London, London, UK.
⁶ St Georges University Hospital NHS Foundation Trust, London, UK.
⁷ Lewisham and Greenwich NHS Trust, London, UK.
⁸ Leeds Teaching Hospitals NHS Trust, Leeds, UK.
⁹ Newcastle Hospitals NHS Foundation Trust, Newcastle, UK.
¹⁰ Chelsea and Westminster NHS Foundation Trust, London, UK.
¹¹ Central and North West London Foundation Trust, London, UK.

PMID: 38529684
DOI: 10.1111/hiv.13640

Abstract

Objectives: To describe HIV care outcomes in people of Black ethnicities living in England during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; coronavirus disease 2019 [COVID-19]) pandemic.

Methods: This was an observational cohort study of people of self-reported Black ethnicities attending for HIV care at nine HIV clinics across England. The primary outcome was a composite of antiretroviral therapy (ART) interruption and HIV viraemia (HIV RNA ≥200 copies/mL) ascertained via self-completed questionnaires and review of medical records. We used multivariable logistic regression to explore associations between ART interruption/HIV viraemia and demographic factors, pre-pandemic HIV immunovirological control, comorbidity status, and COVID-19 disease and vaccination status.

Results: We included 2290 people (median age 49.3 years; 56% female; median CD4 cell count 555 cells/mm³; 92% pre-pandemic HIV RNA <200 copies/mL), of whom 302 (13%) reported one or more ART interruption, 312 (14%) had documented HIV viraemia ≥200 copies/mL, and 401 (18%) experienced the composite endpoint of ART interruption/HIV viraemia. In multivariable analysis, a pre-pandemic HIV RNA <200 copies/mL (odds ratio [OR] 0.21; 95% confidence interval [CI] 0.15-0.30) and being vaccinated against SARS-CoV-2 (OR 0.41; 95% CI 0.30-0.55) were associated with reduced odds of ART interruption/HIV viraemia; pandemic-related disruptions to HIV care were common self-reported additional factors.

Conclusions: During the COVID-19 pandemic, one in six people of Black ethnicities in this HIV cohort experienced an ART interruption/HIV viraemia. Some of these episodes resulted from pandemic-related healthcare disruptions. Associations with suboptimal engagement in HIV care pre-pandemic and not being vaccinated against SARS-CoV-2 suggest that wider health beliefs and/or poor healthcare access may have been contributory factors.

Keywords: COVID‐19; HIV; antiretroviral therapy; black; engagement.

Grants and funding

IN-UK-983-6053/Gilead Sciences