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COVID-19 Vaccination Rates in a Global HIV Cohort
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Download the PDF here
The Journal of Infectious Diseases 18 November 2021
https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiab575/6431673
-----In the high-income super-region, with a significant representation of participants from the
US, vaccination rates were higher among Whites than Blacks. These data confirm lower
vaccination rates for people of color living with HIV globally, for example in sub-Saharan
Africa and Haiti, and also compared to Whites within higher GBD super-regions such as the US[11]. Given data for higher morbidity from COVID-19 among people of color with HIV[2], this disparity is likely to have significant public health implications.
-----Little is known regarding COVID-19 vaccination rates in people with HIV (PWH), a
vulnerable population with significant morbidity from COVID-19. We assessed COVID-19
vaccination rates among 6952 PWH in the Randomized Trial to Prevent Vascular Events in
HIV (REPRIEVE) compared to region- and country-specific vaccination data. The global
probability of COVID-19 vaccination through the end of July 2021 was 55% among
REPRIEVE participants with rates varying substantially by Global Burden of Disease (GBD)
super-region. Among PWH, factors associated with COVID-19 vaccination included
residence in high-income regions, age, White race, male sex, BMI, and higher burden of
cardiovascular risk.
- Cumulative vaccination rates were highest in the High-Income super-region (71%), followed by Latin America and the Caribbean (59%), South Asia (49%), Southeast/East Asia (41%), and Sub-Saharan Africa (18%). Country-
specific rates varied dramatically, with vaccination rates highest in the United States, Peru,
and Brazil, 72%, 69%, and 63% and lowest in South Africa, Uganda, and Haiti with 18%,
3%, and 0%, respectively. - This disparity in COVID-19 vaccination rates among PWH across income regions may increase morbidity from COVID-19 in the most vulnerable HIV populations. For example, the two countries with the largest share of deaths from HIV/AIDS (Botswana and South Africa)[9] demonstrated very low vaccination rates in general compared to high-income countries.
-----Vaccination rates were generally comparable among PWH in REPRIEVE compared to the
general population (Figure 1C), in most GBD super-regions, though key differences were
observed in comparison to the general population in specific countries (Supplemental
Figure 1).
------Among the overall REPRIEVE population, vaccinated participants were more likely to come
from high-income GBD super-region countries and to be White, male, older, have a higher
BMI, higher ASCVD risk score, and longer duration of ART, but did not differ by either
nadir or baseline CD4 count (Supplemental Figures 2-8). Vaccination rates were overall
higher among men in the high income and the S. East/East Asia regions with similar trends in
Latin America and the Caribbean and South Asia. In the high-income GBD super-region,
differences in vaccination rates by race were seen (Figure 2).
-----To our knowledge, this analysis presents the first and largest investigation of vaccination
rates among PWH. Among REPRIEVE participants, vaccination rates were greatest in high-
income countries compared to low-income countries. For example, overall vaccine rates for
PWH in REPRIEVE ranged from 71% in the high-income super-region to 18% in Sub-
Saharan Africa, and by country from 72% in the US to 0% in Haiti. Overall, vaccination rates
mirrored rates for the general population in most GBD super-regions, with specific
differences seen in individual countries. These data allow a specific examination of rates
among PWH, in the context of global rollout policies that differed by region and country (see Supplemental Table 2 for summary of country specific roll-out timelines). Moreover, these data permitted an examination of factors associated with COVID-19 vaccination for the
first time among PWH.
----In our cohort, vaccinated PWH were more likely to be older, have more co-morbidities,
including higher BMI, and higher overall ASCVD risk, across most regions. Increased co-
morbidities among those receiving the vaccine may suggest that such participants were
motivated out of concerns about COVID-related morbidity/mortality, and/or that physicians
recommended the vaccination more often in this context, consistent with many public health
recommendations[10]. Overall, women were less likely to receive the vaccination in high-
income regions and S. East/East Asia, with similar trends in most regions except Sub-Saharan
Africa.
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News Release 10-Dec-2021
ACTG announces publication in the Journal of Infectious Diseases about COVID-19 vaccination rates among people living with HIV in the REPRIEVE trial
Los Angeles, Calif. – The AIDS Clinical Trials Group (ACTG), the largest global HIV research network, which recently expanded its focus to include evaluating outpatient treatment for COVID-19, today announced that insights around COVID-19 vaccination rates among people living with HV have been published in the Journal of Infectious Diseases. The study identified that the global probability of COVID-19 vaccination among participants in the REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) study was 55 percent, with rates varying significantly by geography. Factors associated with COVID-19 vaccination among this cohort of people living with HIV included residence in high-income regions, age, white race, male sex, BMI, and higher burden of cardiovascular risk. The ACTG is funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), and by collaborating NIH institutes.
Little is known about COVID-19 vaccination rates among people living with HIV, who are immunocompromised and have a higher risk of underlying co-morbidities, making them more likely to experience COVID-19-related morbidity and mortality. REPRIEVE is a global cardiovascular disease prevention study among people living with HIV. The data collected on COVID-19 vaccination rates in REPRIEVE provided a unique opportunity to assess rates across global regions.
"This publication marks the first and largest investigation of COVID-19 vaccine rates among people living with HIV, a population that has been particularly affected by the pandemic," said ACTG Chair Judith Currier, M.D., M.Sc., University of California, Los Angeles. "These data provide the field with crucial information about COVID-19 vaccination rates among people living with HIV. They also highlight inequities in vaccination rates across geography, which is likely to have significant public health implications."
Today's publication compared region- and country-specific vaccination rates among people living with HIV enrolled in REPRIEVE to rates in the general population and assessed the characteristics of people living with HIV that were associated with vaccination (defined as at least one dose of any COVID-19 vaccine). Vaccination rates among REPRIEVE participants were compared between Global Burden of Disease super-regions, including high-income (the United States, Canada, Spain), Latin America and the Caribbean (Brazil, Haiti, Peru, Puerto Rico), Southeast/East Asia (Thailand), South Asia (India), and Sub-Saharan Africa (Botswana, South Africa, Uganda, Zimbabwe).
REPRIEVE has enrolled 7,770 participants ages 40-75 who were on stable antiretroviral therapy (ART), had no known cardiovascular risk, and low-to-moderate atherosclerotic cardiovascular disease (ASCVD) risk at enrollment. COVID-19 vaccination rates were identified among 6,952 participants. Cumulative vaccination rates among REPRIEVE participants were highest in the United States (72 percent), Peru (69 percent), and Brazil (63 percent) and lowest in South Africa (18 percent), Uganda (3 percent) and Haiti (0 percent). Rates were highest in the high-income super-region (71 percent), followed by Latin America and the Caribbean (59 percent), South Asia (49 percent), Southeast/East Asia (41 percent), and Sub-Saharan Africa (18 percent).
Rates among REPRIEVE participants generally mirrored rates for the general population in most Global Burden of Disease super-regions. While vaccinated REPRIEVE participants were more likely to come from high-income geographies and to be white, male, older, have a higher BMI, a higher ASCVD risk score, and longer duration of ART, vaccination rates did not differ by nadir or baseline CD4 count. Higher levels of co-morbidities among those receiving the vaccine may suggest that these participants were motivated to get vaccinated out of concern for being at higher risk of severe COVID-19 or because their clinicians were more likely to recommend vaccination in this context. In the high-income super-region, vaccination rates were higher among individuals who identified as white than as Black.
"This is the first study to shed light on global vaccination rates among this high-risk population," said Steven Grinspoon, M.D., Chief of the Metabolism Unit at Massachusetts General Hospital. "These data highlight major differences in COVID-19 vaccination rates by Global Burden of Disease super-regions. Disparities in these vaccination rates among people living with HIV across these geographies may lead to higher morbidity from COVID-19 in the most vulnerable populations of people living with HIV."
REPRIEVE is led by Dr. Grinspoon and Michael Lu, M.D., M.P.H., Massachusetts General Hospital and Harvard Medical School; Pamela Douglas, M.D., Duke University; and Heather Ribaudo, Ph.D., Harvard School of Public Health, in collaboration with the ACTG. The analysis published today was led by Evelynne S. Fulda, B.A., Massachusetts General Hospital, Dr. Ribaudo, and Dr. Grinspoon. REPRIEVE is supported by the NIH's National Heart, Lung, and Blood Institute (NHLBI) and NIAID, as well as by KOWA Pharmaceuticals America, Gilead Sciences, and ViiV Healthcare.
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