• Xinyuan He, Fan Lv, Marissa Fox, Yee Hui Yeo, Biyao Zou, Jinli Liu, Yunyu Zhao, Jian Zu, Yan Li, Weiming Tang, Lei Zhang, and Fanpu Ji.
• Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P. R. China.
• J. Intern. Med. 2023 Aug 1; 294 (2): 178190178-190.

BackgroundUS progress toward ending the HIV epidemic was disrupted during the COVID-19 pandemic.ObjectivesTo determine the impact of the pandemic on HIV-related mortality and potential disparities.MethodsUsing data from the Centers for Disease Control and Prevention and the United States (US) Census Bureau, HIV-related mortality data of decedents aged ≥25 years between 2012 and 2021 were analyzed. Excess HIV-related mortality rates were estimated by determining the difference between observed and projected mortality rates during the pandemic. The trends of mortality were quantified with joinpoint regression analysis.ResultsOf the 79,725 deaths documented in adults aged 25 years and older between 2012 and 2021, a significant downward trend was noted in HIV-related mortality rates before the pandemic, followed by a surge during the pandemic. The observed mortality rates were 18.8% (95% confidence interval [CI]: 13.1%-25.5%) and 25.4% (95%CI: 19.9%-30.4%) higher than the projected values in 2020 and 2021, respectively. Both of these percentages were higher than that in the general population in 2020 (16.4%, 95%CI: 14.9%-17.9%) and 2021 (19.8%, 95%CI: 18.0%-21.6%), respectively. Increased HIV-related mortality was observed across all age subgroups, but those aged 25-44 years demonstrated the greatest relative increase and the lowest COVID-19-related deaths when compared to middle- and old-aged decedents. Disparities were observed across racial/ethnic subgroups and geographic regions.ConclusionsThe pandemic led to a reversal in the attainments made to reduce the prevalence of HIV. Individuals living with HIV were disproportionately affected during the pandemic. Thoughtful policies are needed to address the disparity in excess HIV-related mortality.© 2023 The Association for the Publication of the Journal of Internal Medicine.

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