Health care utilization following SARS-CoV-2 infection among people living with HIV in China during December 2022 -January 2023: A multicenter cross-sectional study

Peng Xu^1,2Qiyu Zhu¹Shu Liang³Yong Xu⁴Qiongli Duan⁵Liang Liang⁶Jinghua Li⁷Liwei Zheng⁷Xingyi Geng⁸Xinrui Li⁸Jun Zheng⁹Daoping Huang¹⁰Dafang Chen¹¹Xiao-Ping Dong^12,13Yingpeng Ma¹Hui Liu¹Yuhua Shi¹⁴Mengjie Han^1,2*

• ¹National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
• ²National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Bejing, China
• ³Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan Province, China
• ⁴Neijiang Center for Disease Control and Prevention, Neijiang, China
• ⁵Center for Disease Control and Prevention in Honghe Hani and Yi Autonomous Prefecture, Mengzi, China
• ⁶Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, Hebei Province, China
• ⁷Baoding Center for Disease Control and Prevention, Baoding, China
• ⁸Jinan Disease Prevention and Control Center, Jinan, Shandong Province, China
• ⁹Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan Province, China
• ¹⁰Changde Center for Disease Control and Prevention, Changde, China
• ¹¹School of Public Health, Peking University, Beijing, China
• ¹²National Institute for Viral Disease Control and Prevention (China CDC), Beijing, Beijing Municipality, China
• ¹³NHC Key Laboratory of Medical Virology and Viral Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
• ¹⁴Yunnan Provincial Center for Disease Control and Prevention, Kunming, Yunnan Province, China

People living with HIV (PWH) are presumed at increased risk of severe COVID-19 outcomes. However, evidence on the association between HIV-specific conditions and COVID-19-related health care utilization remains limited.A multicenter cross-sectional survey was conducted from July to October 2023 to investigate the health care utilization following SARS-CoV-2 infection among PWH during December 2022 -January 2023. A self-designed questionnaire was used to collect data on the demographic information and SARS-CoV-2 infection. HIV-specific factors were extracted from the HIV database. Multivariable logistic regression was performed to examine the associations between health care utilization and HIV-specific factors.A total of 2,433 PWH reported tested-confirmed SARS-CoV-2 infection were recruited, with a mean age of 42.5 (SD 13.4) years. Among them, 98.4% participants reported experiencing symptoms following infection. Furthermore, 222 (9.1%) reported health care utilization, including 176 (7.2%) outpatient visits and 46 (1.9%) hospital admissions. Overall healthcare utilization was significantly associated with CD4 cell counts. Compared to PWH with CD4 ≥ 500 cells/μl at ART initiation, those with CD4 counts of 200-499 cells/μl at ART initiation had higher odds of health care utilization (aOR = 1.72, 95% CI: 1.10-2.78). Additionally, PWH with CD4 < 200 cells/μl at the last visit (aOR = 1.94, 95% CI: 1.08-3.43) were associated with higher health care utilization than CD4 ≥ 500 cells/μl. Compared to non-nucleoside reverse transcriptase inhibitor (NNRTI) based ART regimens, integrase strand transfer inhibitor (INSTI) based ART regimens were associated with lower overall health care utilization (aOR = 0.42, 95% CI: 0.21-0.78) and fewer outpatient visits (aOR = 0.50, 95% CI: 0.24-0.96).Immune status and INSTI use were significantly associated with COVID-19-related health care utilization among PWH.