New insights about COVID-19 vaccination rates among people living with HIV

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. 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."

Judith Currier, M.D., M.Sc., ACTG Chair, University of California, Los Angeles

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.