Associations Between Long COVID Symptoms and Health-related Quality of Life among a Medicaid Managed Care Population Living with HIV

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Background: Lasting symptoms following an infection of acute COVID-19, known as post-acute sequelae of SARS-CoV-2 infection (PASC), negatively impact health-related quality of life in the general population. Although people living with HIV (PLWH) face a higher disease burden compared to people without HIV, there is limited research on how PASC is associated with health-related quality of life among people living with HIV. Methods: This study recruited 107 people living with HIV with a documented diagnosis of COVID-19 from a Medicaid-managed care plan, yielding 105 valid responses. Data were collected via an online survey which collected information on general health status, comorbidities, experiences of PASC symptoms and health-related quality of life. Health-related quality of life was assessed through the EQ-5D instrument. A $20 e-gift card was given to each participant as compensation. Ordinary least squares regression was employed to examine the association between the number of PASC symptoms, comorbidities, and health-related quality of life, controlling for age, gender identity, and race/ethnicity. The study protocol received approval from the Institutional Review Board (IRB) from the City University of New York. Results: The participants had an average age of 48.1 years (SD=10.5). The sample consisted of 54% cisgender males, 34% cisgender females, and 12% transgender/gender-diverse individuals, and 53% identified as sexual minorities. The largest racial/ethnic group was non-Hispanic Black (45%), followed by Hispanic (43%). Most PLWH (90%) reported undetectable HIV viral loads. On average, participants reported 2.2 comorbidities in addition to HIV (SD=1.5), and 42% rated their health as good/excellent. Nearly half (49%) reported one or more PASC symptoms lasting six months or more (M=5.3, SD=8.0). The number of PASC symptoms was significantly associated with poorer health-related quality of life (β=.33, R2=.31), with more variance in health-related quality of life than comorbidities and self-rated health combined (βs=.32 and .28, respectively, R2=.14). Conclusions: PASC adversely affected health-related quality of life among people living with HIV. Routine assessment for PASC symptoms should be a standard practice in clinical settings for people living with HIV who have been diagnosed with COVID-19. These findings also underscore the importance of ongoing support for PLWH with a history of COVID-19 infection, and the need to focus on domains of health beyond HIV.