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

• Published in: HIV medicine Vol. 25; no. 7; pp. 885 - 892
• Main Authors: Ottaway, Zoe, Campbell, Lucy, Fox, Julie, Burns, Fiona, Hamzah, Lisa, Kegg, Stephen, Rosenvinge, Melanie, Schoeman, Sarah, Price, David, Jones, Rachael, Miller, Robert F., Tariq, Shema, Post, Frank A.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-07-2024
• Subjects: Adult; Antiretroviral agents; Antiretroviral therapy; black; Black People - statistics & numerical data; CD4 antigen; CD4 Lymphocyte Count; Cohort Studies; Comorbidity; Coronaviruses; COVID-19; COVID-19 - epidemiology; COVID-19 - prevention & control; COVID-19 vaccines; engagement; England - epidemiology; Ethnicity; Female; Health care; HIV; HIV Infections - drug therapy; Human immunodeficiency virus; Humans; Male; Medical records; Middle Aged; Observational studies; Pandemics; Public health; Respiratory diseases; Ribonucleic acid; RNA; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Statistical analysis; Vaccination; Viral diseases; Viral Load; Viremia; England; United Kingdom > UK; black; engagement; COVID‐19; HIV; antiretroviral therapy
• ISSN: 1464-2662; 1468-1293; 1468-1293
• DOI: 10.1111/hiv.13640

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.