Sociodemographic factors influencing SARS-CoV-2 vaccination uptake in people with and without HIV: Insights from a Swedish Nationwide cohort

There is limited data regarding SARS-CoV-2 vaccine uptake in people with HIV (PWH) compared to people without HIV (PWoH). Swedish nationwide study of individuals born 1930-2003, assessing SARS-CoV-2 vaccine uptake of 1-5 doses by HIV-status from first SARS-CoV-2 vaccination (2020-12-27) until 2023-02-23. PWH were categorized by prioritization: clinically vulnerable (CD4+ T-cells <50cells/μL, recent opportunistic disease, or CD4+ T-cells <200 in combination with detectable HIV-RNA > 200copies/mL), and not prioritized (non-vulnerable PWH). Relative risks (adjRR) for doses 1-5 were estimated using modified Poisson regression, adjusted for sociodemographics, SARS-CoV-2 infections, and comorbidities. 7233 non-vulnerable PWH, 435 clinically vulnerable PWH, and 8,168,340 PWoH were included. While unadjusted 3-dose uptake was lower in both PWH groups compared to PWoH, adjusted analysis showed higher uptake in non-vulnerable PWH (adjRR1.17, 95 % CI 1.15-1.19), with similar trends in clinically vulnerable. An interaction between country of birth and HIV-status was identified (p < 0.001). Migrants with HIV had higher 3-dose uptake vs. migrants without HIV, but were less likely vaccinated than Swedish-born with HIV. Among people ≥65 years old, PWH were less likely to receive 3 or more doses compared to PWoH ≥65 years (dose 5: adjRR 0.90, 95 % CI 0.85-0.96). We found lower vaccination uptake in migrants, irrespective of HIV-status, consistent with previous studies. Most concerningly we identified a lower vaccine uptake among people with HIV who were 65 years or older. This nationwide study highlights the need for targeted vaccination strategies and interventions that address both HIV-status and demographic factors.