HIV Status and COVID-19 Treatment Disparities in the US National Clinical Cohort Collaborative

Background While disparities in COVID-19 therapeutic access have been documented, the effect of HIV status on treatment access and how it intersects with other sociodemographic factors has not been well explored. Using data from the National Clinical Cohort Collaborative (N3C), we investigated disparities in COVID-19 therapeutic prescription among persons with HIV and without HIV. Methods This was a retrospective cohort study of patients’ data from January 2020 to November 2024. The study included 7 806 412 patients with a COVID-19 diagnosis, of whom 45 508 (0.58%) were persons with HIV. We employed logistic and linear regression models to assess associations between therapeutic receipt and patient characteristics. Results Persons with HIV had significantly higher adjusted odds of receiving COVID-19 therapeutics compared to persons without HIV (remdesivir, aOR 1.26 [95% CI: 1.20, 1.33]; nirmatrelvir/ritonavir, aOR 2.86 [95% CI: 2.77, 2.95]). Despite this, significant racial/ethnic inequities were observed. American Indian or Alaskan Native persons with HIV (estimated coefficient 0.997) and Hispanic/Latinx persons with HIV (estimated coefficient 0.992) had a lower estimated prevalence of remdesivir receipt compared to White Non-Hispanic individuals. For nirmatrelvir/ritonavir, Black/African American individuals (persons with HIV, estimated coefficient 0.947; persons without HIV, estimated coefficient 0.943), American Indian or Alaskan Native persons with HIV (estimated coefficient 0.996), and Hispanic/Latinx individuals (estimated coefficient 0.992) showed a lower estimated prevalence of receipt compared to their White counterparts. Conclusions Persons with HIV demonstrated higher odds of receiving COVID-19 therapeutics than persons without HIV. However, persistent racial and ethnic inequities in treatment uptake were evident.