COVID-19 Vaccination Gap Between PLWH, General Population in New York

COVID-19 vaccination coverage among people living with HIV (PLWH) in New York state was lower than that of the general adult New York population, according to a CDC Morbidity and Mortality Weekly Report. New York has the highest US per capita rate of PLWH.

Researchers collected data from the New York State HIV surveillance registry and matched it with the New York City Citywide Immunization Registry and the New York State Immunization Information System. They also used an algorithm to find out the vaccination status as of October 24, 2021, among adults—defined as aged 18 and older—living with HIV.

Approximately 2.5 million COVID-19 cases and 58,000 COVID-19-related deaths were recorded in New York between March 1, 2020, and October 26, 2021. Population-level analyses adjusting for age, sex, and region have shown that PLWH are at elevated risk for severe COVID-19–related outcomes, such as hospitalization and death, compared with people without and HIV diagnosis.

However, vaccination rates specifically among people in New York living with HIV have not been as heavily analyzed.

Data on COVID-19 deaths among PLWH were only available up to December 2020. To make up for this lost information, researchers took into account deaths among PLWH in New York from previous years—including 2020—and estimated between 500 and 1000 deaths from early 2021, before vaccines became available.

A total of 101,205 PLWH in New York were included in the analysis. Booster and additional doses were not taken into account. Most individuals were male (70,636), non-Hispanic Black (45,534), aged 18 to 64 (86,142) years, and lived in New York City (79,433). Additionally, a majority (75,898) were virally suppressed—defined as less than 200 HIV RNA copies/mL—or received HIV care in 2020 (86,790).

Of this group, 64,278 (63.5%) received a primary vaccine series, either the Johnson & Johnson (J&J) vaccine or 2 doses of the Pfizer-BioNTech or Moderna vaccines. Full primary series vaccination increased with age, and was higher among men (64.8%) compared with women (60.5%) and persons who identified as nonbinary or gender nonconforming (58.1%).

Not including J&J, 4349 (4.3%) persons only received 1 dose of the Pfizer-BioNTech or Moderna vaccine; the report did not specify if individuals in this group intended on receiving a second dose. A considerable amount of PLWH (32,578; 32.2%) were unvaccinated during the analysis period, despite being an early priority group for COVID-19 vaccination.

Based on race and ethnicity, coverage was highest among non-Hispanic Whites (70.8%) and lowest among non-Hispanic Blacks (58.6%) and American Indians or Alaska Natives (58.4%).

Vaccine coverage was also notably lower among PLWH who were not virally suppressed at their last test in 2020 (38.1%) vs people who were (72.0%). Coverage was also lower among people with no surveillance-based evidence of HIV care in 2020 (29.1%) compared with those receiving care (69.2%).

The authors also noted that differences in demographic composition between PLWH and the general New York population may partially explain the gap coverage. At the same time, vaccine coverage was less than 75% across all included subgroups of PLWH.

Socioeconomic status, age at HIV diagnosis, and area of residence—other than in or not in New York City—were not measured in this particular analysis, although the authors noted that those factors may further explain the lower COVID-19 vaccination coverage among PLWH.

As noted in the report, PLWH who are Hispanic or non-Hispanic Black are more likely to be infected with SARS-CoV-2 and experience severe COVID-19–related outcomes vs non-Hispanic White PLWH.

“Addressing the large disparity in vaccination coverage by HIV care and viral suppression status is of particular importance, given the increased likelihood of severe COVID-19–related outcomes among PLWDH [persons living with diagnosed HIV] who experience immunocompromising conditions and considering the specific recommendation for additional doses for this group,” the report authors said. “In addition to primary vaccination coverage, ensuring that PLWDH receive booster doses is critically important moving forward.”

Reference

Tesoriero JM, Patterson W, Daskalakis D, et al. COVID-19 vaccination among persons living with diagnosed HIV infection — New York, October 2021. MMWR Morb Mortal Wkly Rep. 2022;71(5);182-184. doi:10.15585/mmwr.mm7105a4