Study results indicate that outcomes were worse among those who inject illicit drugs and Black patients living with HIV.
Due to the COVID-19 pandemic, previous accomplishments in controlling HIV blood levels and worsened health disparities were slowed. Although progress was being made on the goal to reduce HIV before COVID-19, researchers determined that the pandemic had compromised the steps by leveling off improvements in the overall population.1
A study published in Clinical Infectious Diseases examined the changes in the proportion of people with HIV who have virologic suppression. The study, which evaluated 17,999 patients across 8 large HIV clinics, also found that outcomes were worse among Black patients and those who inject illicit drugs. Data were collected from January 1, 2018, to January 1, 2022, and data prior to the COVID-19 pandemic (January 1, 2018 to March 21, 2020) was compared to data after the pandemic (March 22, 2020, to January 1, 2022), with outcomes continuing to be tracked as it progressed.1,2
“Equity in HIV outcomes likely worsened during the pandemic, with decreased access to necessary care and increased socioeconomic impacts disproportionately affecting these populations,” said the study’s first author, Matthew Spinelli, MD, assistant professor in the Division of HIV, Infectious Diseases and Global Medicine at UCSF and the Pricilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center, in a press release.
Prior progress in controlling the virus came to a standstill for the general population after the COVID-19 pandemic began. Certain populations, particularly in Black patients and those with a history of injection drug use, experienced worse conditions due to the pandemic. The percentage of Black patients who kept their viral loads suppressed had decreased from 87% to 85%, and for those who use injectable drugs, dropped from 84% to 81%.
Shelter-in-place orders had limited the access to care for patients, especially in those who were already experiencing health disparities. Factors included the transition to virtual telehealth appointments to provide HIV services as well as reduced in-person visits. Spinelli noted that the study results demonstrate that the United States will likely not be able to reach the goals for Ending the HIV Epidemic in the US initiative, which aims to improve HIV prevention and treatment strategies while reducing new HIV infections by 75% by 2025 and 90% by 2030.
“We will need to redouble our efforts in responding to the HIV epidemic to regain our momentum, with a focus on improving health equity so that no-one is left behind,” Spinelli said in the press release.1
1. UC San Francisco. How COVID-19 compromised U.S. gains in controlling HIV. News release. November 14, 2023. Accessed November 20, 2023. https://www.eurekalert.org/news-releases/1008103
2. Spinelli, M, Christopoulos, K, Moreira, V, et al. Viral Suppression Trajectories Destabilized After Coronavirus Disease 2019 Among US People With Human Immunodeficiency Virus: An Interrupted Time Series Analysis. Clinical Infectious Diseases, 2023; ciad657, https://doi.org/10.1093/cid/ciad657
3. Ending the HIV Epidemic: A Plan for America. Centers for Disease Control and Prevention. Published 2019. https://www.cdc.gov/endhiv/index.html