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HIV Status and COVID-19 Treatment Disparities in the US National Clinical Cohort Collaborative

Emmanuel Nazaire Essam Nkodo1, Pooja Maheria2, Eric Hurwitz3

  • 1Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.

Open Forum Infectious Diseases
|January 19, 2026
PubMed

Insights

People with HIV had better access to COVID-19 therapeutics, but racial and ethnic disparities in treatment were still observed. This highlights ongoing inequities in care despite higher overall access for this group.

Area of Science:

  • Infectious Diseases
  • Public Health
  • Health Equity

Background:

  • COVID-19 therapeutic access disparities are known.
  • The impact of HIV status on treatment access and its intersection with sociodemographics is under-explored.

Purpose of the Study:

  • To investigate disparities in COVID-19 therapeutic prescription among persons with and without HIV.
  • To analyze how HIV status intersects with sociodemographic factors in accessing COVID-19 treatments.

Main Methods:

  • Retrospective cohort study using data from January 2020 to November 2024.
  • Included 7,806,412 patients with COVID-19, of whom 45,508 (0.58%) had HIV.
  • Logistic and linear regression models were used to assess treatment receipt associations.

Main Results:

  • Persons with HIV had higher odds of receiving remdesivir (aOR 1.26) and nirmatrelvir/ritonavir (aOR 2.86) compared to those without HIV.
  • Significant racial/ethnic inequities were observed, with American Indian/Alaskan Native and Hispanic/Latinx persons with HIV showing lower remdesivir receipt.
  • Black/African American, American Indian/Alaskan Native, and Hispanic/Latinx individuals (with and without HIV) had lower nirmatrelvir/ritonavir receipt compared to White counterparts.

Conclusions:

  • Persons with HIV had increased odds of receiving COVID-19 therapeutics.
  • Persistent racial and ethnic inequities in treatment uptake were evident despite higher overall access for persons with HIV.
Abstract

Keywords:
COVID-19DisparitiesHIVnirmatrelvir/ritonavirremdesivir

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