HIV and COVID-19: Intersecting Epidemics With Many Unknowns

Catherine R. Lesko; Angela M. Bengtson


Am J Epidemiol. 2021;190(1):10-16. 

In This Article

Current and Future Directions: Opportunities and Challenges

Data that can help answer many of these questions are already being collected (or their collection is planned) but are not yet available for analyses. Because many cohorts of PLWH predate the emergence of SARS-CoV-2, the research infrastructure exists to quickly expand and adapt data collection to monitor changes in health, health-care access and engagement, and risk behaviors associated with all phases COVID-19 pandemic and the implementation and relaxation of physical distancing policies.

Interval and clinical cohorts are working overtime to implement questions designed to address some of the unknowns about HIV and COVID-19, including documenting the impact of SARS-CoV-2 in PLWH and the impact of the physical distancing regulations and associated economic challenges on the lives of PLWH, with special attention to PLWH with comorbid conditions, including mental health and substance use disorders. Some challenges to these efforts include the need to administer focused questionnaires over the internet or telephone and to compensate individuals for their time electronically, particularly when they don't have bank accounts to accommodate those transactions through some of the most common methods.

Clinical cohorts and electronic health systems are in a unique position to document some of the health impacts of SARS-CoV-2 in PLWH by capturing clinical illness, severity, and outcomes in a well-defined population, including (as time and testing capacity increases) seropositivity. Beyond estimating the association between HIV-specific indicators (CD4 cell count, HIV viral load, ART regimen) and COVID-19 outcomes, these clinical cohorts already collect data on other comorbidities and structural vulnerabilities hypothesized to be associated with COVID-19 outcomes based on other studies, and those hypotheses could be rigorously tested. Such analyses should clearly state whether they are descriptive, and then avoid overadjustment, or whether they seek to identify the causal effects, and then choose their adjustment set appropriately. Additionally, clinical cohorts are potentially well-positioned to document impacts of the COVID-19 pandemic on modifications to and interruptions in HIV care.