People with HIV nearly 50% more likely to receive flu vaccine
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People with HIV were nearly 50% more likely to receive influenza vaccination than people without, although patients with more complex health care needs had reduced uptake, according to a study from Kaiser Permanente Northern California.
“We know that people with HIV were especially vulnerable to complications relating to flu and other viral infections,” Michael Silverberg, PhD, MPH, an HIV epidemiologist and research scientist with the Kaiser Permanente Division of Research, told Healio. “Thus, we were interested in evaluating the success of a vaccination program in this population, as well as factors that make it more or less likely for people to receive the vaccine.”
He added, “We hoped that results could inform future outreach efforts.”
Silverberg and colleagues pulled data from the electronic health records of people with HIV (PWH) and people without HIV (PWoH) receiving care at Kaiser Permanente Northern California across six influenza seasons from 2013 to 2018. Using these data, the researchers assessed vaccination uptake among these patients and evaluated factors associated with vaccination.
In total, 9,272 PWH and 194,393 PWoH were matched by age, sex and race/ethnicity, and were ultimately included in the study.
Overall, the study demonstrated that PWH were more likely to receive the influenza vaccine during each of the years assessed (2013: 69% vs. 39%; 2014: 65% vs. 37%; 2015: 66% vs. 37%; 2016: 67% vs. 37%; 2017: 67% vs. 40%; 2018: 68% vs. 41) compared with PWoH, with an adjusted RR of 1.48 (95% CI, 1.46-1.50).
After assessing the groups individually, researchers found that lower vaccination uptake among PWH was associated with factors suggesting more complex health needs.
Examples of this were PWH with a CD4 count of 500 cells/mm3 or more had a higher likelihood of vaccination, whereas those with a CD4 count of 200 to 349 cells/mm3 (aRR = 0.96; 95% CI, 0.92-0.99) and less than 200 cells/mm3 (aRR = 0.89; 95% CI, 0.84-0.95) were less likely to receive an influenza vaccine.
Similarly, PWH with a HIV viral load of 200 copies/mL or more were less likely to receive the influenza vaccine compared with those with a HIV viral load of less than 200 copies (aRR = 0.81; 95% CI, 0.77-0.86).
The study also showed that prior depression diagnoses, having Medicare insurance and having a higher number of comorbidities was also associated with a lessened likelihood of vaccination.
These findings were in contrast with those assessed among PWoH. According to the study, PWoH who had a higher Charlson comorbidity score, a prior diagnosis of depression and Medicare insurance, for example, were more likely to be vaccinated.
The researchers wrote that the reason for these contrasts is unknown.
“Although it is encouraging that influenza vaccination rates were relatively high in people with HIV, there is more that we can do to protect this population further,” Silverberg said. “Specifically, it is essential that providers and health care organizations do more to target particularly vulnerable people with HIV, such as those with more complex health needs.”
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