A study focused on the vaccination rates among individuals during the COVID-19 pandemic, specifically comparing people with HIV (PWH) to people without HIV (PWoH). PWH were less likely to complete the primary vaccination series but more likely to receive booster doses compared to PWoH. The lower vaccination rates among specific subgroups of PWH underline the need for targeted interventions to increase vaccination uptake, especially considering their higher risk of comorbidities. The higher uptake of booster doses among PWH, however, suggests that once initial hesitancy or barriers are overcome, this group may be more proactive or receptive to additional doses.

The analysis revealed that, despite PWH generally having a higher incidence of comorbid conditions, they had a lower rate of completing the primary vaccination series (78.2%) compared to PWoH (81.8%), with the difference being statistically significant (p < 0.001). PWH showed a higher rate of receiving booster doses (68.5%) compared to PWoH (63.1%), also with a statistically significant difference (p < 0.001). The study also identified that among PWH, individuals with less than 200 CD4 cells/μL, those with detectable levels of HIV viremia, and migrants were significantly less likely to have completed the primary vaccination series compared to their counterparts without HIV (p < 0.001 for all comparisons).

“In our study, the primary vaccination coverage in the overall population (PWH and PWoH) was 81.4%, surpassing the regional average of 75.1% reported by the European Centre for Disease Prevention and Control (ECDC),” according to investigators. “Similarly, the observed coverage of booster vaccinations in our cohort was 65.3%, also exceeding the reported regional average of 54.8%.”

The increased likelihood of receiving a booster dose among PWH who have CD4 levels below 200 cells/uL is promising, especially given their higher risk of severe COVID-19 complications and the alignment with public health guidelines. However, the reduced uptake of booster doses among PWH with detectable viral loads highlights a critical area for improvement. Amid the rise of the Omicron variant in Catalonia, the introduction of the monovalent SARS-CoV-2 vaccine, which has shown to be more immunogenic as a booster against Omicron than the initial two-dose series, underscored the importance of targeted efforts to increase booster vaccination among vulnerable groups like PWH. Such individuals are particularly in need of booster doses to mitigate the risk of breakthrough infections.

“The observed lower SARS-CoV-2 primary vaccination rates among PWH compared to PWoH in Catalonia are concerning,” according to the investigators. “This trend aligns with a global HIV cohort and a study conducted in New York, indicating a consistent pattern of reduced vaccination coverage among PWH. The observed disparities in SARS-CoV-2 vaccination rates among PWH could be attributed to various factors, including potential barriers and hesitancy toward vaccination. Even before the pandemic, vaccine hesitancy was recognized as a significant global health concern by the World Health Organization. Concerns about the safety of the new SARS-CoV-2 vaccines have been a primary reason for vaccine refusal, as highlighted in reports. Furthermore, access barriers, including limited availability or insufficient information tailored to the needs of PWH, could contribute to lower vaccination rates within this population.”

The study also acknowledges several limitations. First, the measure used to assess socioeconomic deprivation is based on the area where an individual lives, which might not accurately reflect their actual socioeconomic status. Second, information on participants’ experiences following vaccination, especially any side effects from the initial vaccine doses that could affect their willingness to get booster shots, was not collected. Third, our study’s design may not account for all influencing factors due to unreported variables like religion and occupation, which can affect attitudes toward vaccination, in our database. Moreover, our database does not include information on home-administered SARS-CoV-2 antigen tests, so we cannot determine if or how this may have impacted individuals’ decisions regarding vaccination.

This observation implies that PWH and their healthcare providers might actively pursue booster vaccinations to strengthen their immune response, especially considering evidence showing insufficient immune responses and worse clinical outcomes in cases of HIV and SARS-CoV-2 co-infection.

Reference

1. Nomah DK, Reyes-Urueña J, Alonso L, et al. Comparative analysis of primary and monovalent booster sars-cov-2 vaccination coverage in adults with and without hiv in catalonia, spain. National Library of Medicine. Published December 30, 2023. Accessed February 2, 2024. doi: 10.3390/vaccines12010044