Impact of the COVID-19 Pandemic on Treatment Outcomes and Healthcare Utilization Among People Living With HIV in Korea: A Multicenter Cohort Study

초록

Background: The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare delivery worldwide, raising concerns about continuity of care for people living with HIV (PLWH). However, its long-term effect on HIV treatment outcomes in resource-rich settings with robust public health infrastructure remains unclear. Therefore, this study aims to evaluate the effects of the COVID-19 pandemic on virological outcomes, immunological status, healthcare utilization, medication adherence, and mortality among PLWH enrolled in the Korea HIV/AIDS Cohort. Methods: A retrospective longitudinal analysis was conducted using the Korea HIV/AIDS Cohort data collected between 2018 and 2023. Outcomes during the pre-pandemic (2018-2019) and pandemic (2020-2023) periods were compared. The primary outcome was virological failure, defined as an HIV RNA level >= 200 copies/mL. Secondary outcomes included CD4+ T-cell count, opportunistic infections, visit adherence (>= 2 clinic visits/year), all-cause mortality, and visual analog scale-assessed self-reported medication adherence. Repeated-measures analyses were performed using generalized estimating equations with an exchangeable correlation structure, adjusted for age and sex. Mortality risk was evaluated using Cox proportional hazards models, with subgroup and sensitivity analyses also performed. Results: Overall, 1,674 patients contributed 9,721 visits. Virological failure decreased from 3.2% pre-pandemic to 1.2% during the pandemic (adjusted odds ratio [OR], 0.37; 95% confidence interval [CI], 0.27-0.50; P < 0.001). CD4+ T-cell counts were higher during the pandemic (beta = +33.2 cells/mm3; 95% CI, 23.3-43.1; P < 0.001). Medication adherence improved from 85.3% to 90.2% (adjusted OR, 1.58; P < 0.001), despite reduced visit adherence (81.6% to 60.5%; adjusted OR, 0.49; 95% CI, 0.45-0.54; P < 0.001). All-cause mortality did not differ between periods (hazard ratio, 0.32; 95% CI, 0.07-1.51; P = 0.151), with consistent findings across subgroup and sensitivity analyses. Conclusion: Despite reduced clinic utilization during the COVID-19 pandemic, PLWH in Korea maintained or improved virological and immunological outcomes. These observational findings support the feasibility of less intensive monitoring for selected virologically stable individuals. However, given the potential for survivorship bias and unmeasured confounding, prospective studies are required before changes to monitoring practice can be recommended.

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