It is not known if people with HIV (PWH) in the United States (US) have different access to SARS-CoV-2 RT-PCR (COVID-19) testing, or positivity proportions (among those tested), than people without HIV (PWOH). We describe COVID-19 testing and positivity proportions in 6 large geographically and demographically diverse cohorts of PWH and PWOH.
The Corona-Infectious-Virus Epidemiology Team (CIVET) is comprised of five COVID-19 clinical cohorts within a health system (Kaiser Permanente Northern California, Oakland, CA; Kaiser Permanente Mid-Atlantic States, Rockville, MD; University of North Carolina Health, Chapel Hill, NC; Vanderbilt University Medical Center, Nashville, TN; Veterans Aging Cohort Study) and one established classical HIV cohort (MACS/WIHS Combined Cohort Study). Each participating cohort is restricted to individuals who were alive and ‘in-cohort’ in 2020 (definitions of which were operationalized to fit the structure of each cohort). We calculated the percentage of patients in-cohort who were COVID-19 tested, and the proportion COVID-19 positive monthly, by HIV status, from March 1 to August 31, 2020. We report findings from the classical cohort separately because results are based on self-reported information.
In the 5 clinical cohorts, PWH ranged from N=2,515 to 31,040, and N=77,019 to 3,710,360 PWOH. Over the 6 month study period, the percentage of PWH who were tested for COVID-19 (13.5%-21.2%) was slightly higher than PWOH (10.8%-14.3%) in each of the cohorts (p-values in each cohort <0.001). However, among those tested, the percentage of patients with positive COVID-19 tests was similar regardless of HIV status (Figure). In the classical cohort that contributed self-reported testing and positive information (PWH N=2,222; PWOH N=1,417), the proportion tested was similar by HIV status (PWH 38.1% vs. PWOH 37.4%), but PWH had a greater positivity proportion (9.0%) compared with PWOH (5.3%, p-value=0.012).
Although PWH had higher testing rates compared with PWOH, we did not find evidence of increased positivity among those tested in 5 clinical cohorts with large diverse populations across the US. We will continue to monitor testing, positivity, and COVID-19 related health outcomes in PWH and PWOH using our multiple data sources and leveraging the expertise of established longitudinal cohort studies in the CIVETS collaboration.
