Examining the Interplay of COVID-19 and HIV: Impacts on HIV Care, Disparities, and Long-Term Outcomes - Abstract
COVID-19 may have negatively impacted efforts aimed at EHE and exacerbated disparities in HIV
outcomes. For EHE to be successful, it is important to understand any lasting impacts that adversely
complicate HIV control and impact care of people with HIV (PWH), and to address structural issues at the root
of disparities during and after an overlapping pandemic. The impact of post COVID conditions (PCC) PCC on
HIV outcomes has not been studied. While PCC has been documented to increase incident comorbidities and
complications, data on the epidemiology of PCC are lacking for PWH. It is critical to understand
epidemiological risk and any long-term increases in comorbidities among PWH due to SARS-CoV-2 to inform
care and support. The goal of the proposed study is to understand the clinical and social factors that impact
HIV and COVID-19 outcomes among PWH and to characterize how the COVID-19 pandemic, including PCC,
may influence HIV care outcomes. This research will leverage established cohorts: 1) clinical cohorts of PWH
and PWoH from the Johns Hopkins Healthcare System and Kaiser Permanente Mid-Atlantic States and 2) the
CHASING COVID Cohort, an online community-based cohort of US adults.
The proposed research poses unique methodological challenges due to the varying definitions of PCC, the
quantity of exposure data and the longitudinal design, all of which may increase measurement error. This K01
will provide experience, knowledge and training in methods (advanced biostatistics methods related to
improving inferences in settings with complex exposure pathways and measurement error) and content
(comorbidity development among PWH, including PCC, and social determinants of health). The study aims to:
(1) compare clinical risk factors for PCC-related comorbidities by HIV status using target trial approaches with
marginal structural models for time-varying confounding and outcome censoring; (2) characterize the role of
social determinants of PCC-related comorbidities by HIV status using multi-level models; and (3) assess the
role of COVID-era factors on disparities in HIV outcomes, using a novel mediation approach in combination
with modern approaches for minimizing bias (e.g., potential-mediator weighted models).
Focusing the research, in part, on PCC will provide an opportunity to address a complicated and multi-
faceted problem lacking robust epidemiological data for PWH. Findings from the proposed study are critical to
understanding the longer-term impact of COVID-19 on HIV outcomes, disparities in HIV and COVID outcomes,
the epidemiology and natural history of PCC within an immunocompromised population, and pandemic
preparedness for PWH and EHE. Other innovations include: 1) triangulating electronic health record data with
reported data from one of the few national-community-based cohorts and 2) improving inference by
incorporating advanced design and methods with clinical insight. Furthermore, the focus on clinical and social
pathways is critical for identifying the next generation of HIV interventions for EHE.
