Examining the Interplay of COVID-19 and HIV: Impacts on HIV Care, and Long-Term Outcomes - MODIFIED ABSTRACT As a co-occurring condition, SARS-CoV-2 may have negatively impacted efforts aimed at Ending the HIV epidemic (EHE) and worsened HIV outcomes in the long-term. For EHE to be successful, it is important to understand factors that adversely complicate HIV control and impact care of people with HIV (PWH) and to address issues at the root of worsening outcomes. The impact of post COVID conditions (PCC) on HIV outcomes has not been studied, and data on the epidemiology of PCC are lacking for PWH. It is critical to understand epidemiological risk and any long-term increases in comorbidities and complications among PWH due to a co-occurring condition in order to inform care and support. The goal of the proposed study is to understand the factors that impact PCC among PWH and to characterize how 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 causal inference). 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 determinants of PCC-related comorbidities among HIV status using multi-level models; and (3) assess the role of PCC on differences 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 a co-occurring condition on HIV outcomes and the epidemiology and natural history of PCC within an immunocompromised population. 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 determinants and pathways is critical for implementation science and for identifying the next generation of HIV interventions for EHE.
