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COVID Vax More Likely in Older, Heavier
Men (vs Women) in Global HIV Trial
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2022 CROI, February 12-16 and 22-24, 2022
Mark Mascolini
In an ongoing statin trial involving 7770 people with HIV across the world, participants were more likely to get a COVID-19 vaccine if they were male, heavier, older, and taking antiretroviral therapy (ART) for a longer time [1]. A higher proportion of whites than blacks got vaccinated. And trial participants in sub-Saharan Africa had much lower COVID vaccine rates than people in high-income countries, Latin America, or South or Southeast Asia.
People with HIV infection run a higher risk of COVID-related morbidity and mortality because of their compromised immune system and high comorbidity burden, noted REPRIEVE trial investigators who conducted the COVID vaccine analysis. These higher risks hold true even in people whose HIV is well controlled by ART, the investigators added.
REPRIEVE is an international randomized trial comparing pitavastatin with placebo in preventing cardiovascular disease in people with HIV [2]. Participants live in one of five regions: high-income countries (US, Canada, Spain), Latin America/Caribbean (Puerto Rico, Brazil, Peru, Haiti), South Asia (India), Southeast/East Asia (Thailand), and sub-Saharan Africa (Botswana, South Africa, Zimbabwe, Uganda). Enrollees must be 40 to 75 years old, taking stable ART, and free of cardiovascular disease when entering the study.
The 7770 REPRIEVE participants enrolled between March 2015 and July 2019 have a median age of 50 years, and a median time since HIV diagnosis of 13 years. While 31% of participants were female at birth, 43% are black or African American.
Researchers collected COVID vaccination data every 4 months starting in December 2020 and used Kaplan-Meier methods to determine cumulative probability of vaccination. General-population COVID vaccination rates in REPRIEVE countries came from well-known publicly available databases. The investigators defined vaccination as at least one dose of any COVID vaccine.
At CROI the REPRIEVE team presented data from December 2020 to December 2021. By the end of July 2021 about 55% of trial participants had been vaccinated. That rate hit a plateau around 74% by December 2021. At that point Southeast Asia had the highest vaccination rate, 93%, while sub-Saharan Africa had the lowest, 48%. The other three trial regions all reached vaccination rates around 70% by December 2021. In high-income countries and Latin America, trial participants had vaccination rates similar to the general population in those regions, while rates were higher in REPRIEVE than in the general population in Southeast Asia, South Asia, and sub-Saharan Africa.
REPRIEVE participants who identified themselves as white got vaccinated more frequently than blacks in high-income countries as well as in Latin America and the Caribbean. Among all participants, Asians had a slightly higher vaccination rate than whites by December 2021.
In two regions, high-income countries and Southeast Asia, significantly more men than women got vaccinated (P = 0.006 in both regions), although at the end of follow-up, this difference was barely noticeable when graphed. Men had a graphically visible though not quite statistically significantly higher vaccination rate than women in Latin America (P = 0.08). Differences in sample size may play a role in these apparent discrepancies. In sub-Saharan Africa and South Asia, vaccination uptake did not differ significantly between men and women.
Trial participants 60 and older got vaccinated significantly more often than those 50 to 59 years old, who had a higher vaccination rate than 40- to 49-year-olds (P < 0.0001). People taking ART longer (who would generally be older than those with less ART experience) got vaccinated significantly more often than people with a shorter ART duration (10+ years vs 5 to 10 years, vs under 5 years, P < 0.0001). Higher body mass index (30 kg/m2 or higher vs 25 to 29.9 vs 18.5 to 24.9 vs below 18.5) also significantly favored vaccination (P < 0.0001).
The REPRIEVE investigators summarized their findings as underlining “significant disparities in COVID-19 vaccination across different geographic regions” in people with HIV, adding that these disparities persist in high-income regions. The researchers also observed that at least two of these disparities—higher vaccination uptake in older people and those with higher body mass index—reasonably reflect what is known about COVID morbidity and mortality risk. On the other hand, in many populations studied men generally succumbed to COVID more often than women, but no one would suggest that as a rationale for having men step to the front of the COVID vaccine line. The study echoes what is already known about starkly lower COVID vaccine rates in sub-Saharan Africa.
References
1. Fulda ES, Fitch K, Overton ET, et al. COVID-19 vaccination rates in a global HIV cohort. 2022 CROI, February 12-16 and 22-24, 2022. Abstract 50.
2. REPRIEVE Randomized Trial to Prevent Vascular Events in HIV. https://www.reprievetrial.org/
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