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

Killander Möller, Isabela ; Hedberg, Pontus ; Wagner, Philippe LU ; Sparén, Pär ; Gisslén, Magnus ; Nauclér, Pontus LU ; Aleman, Soo ; Bergman, Peter and Carlander, Christina (2025) In Vaccine 62.
Abstract

BACKGROUND: There is limited data regarding SARS-CoV-2 vaccine uptake in people with HIV (PWH) compared to people without HIV (PWoH).

METHODS: 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... (More)

BACKGROUND: There is limited data regarding SARS-CoV-2 vaccine uptake in people with HIV (PWH) compared to people without HIV (PWoH).

METHODS: 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.

RESULTS: 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).

CONCLUSIONS: 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.

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contributor
LU
author collaboration
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Humans, HIV Infections/epidemiology, Sweden/epidemiology, Female, Male, COVID-19 Vaccines/administration & dosage, Middle Aged, COVID-19/prevention & control, Adult, Vaccination/statistics & numerical data, Aged, Sociodemographic Factors, SARS-CoV-2/immunology, Cohort Studies, Young Adult
in
Vaccine
volume
62
article number
127580
publisher
Elsevier
external identifiers
  • scopus:105012633880
  • pmid:40782463
ISSN
1873-2518
DOI
10.1016/j.vaccine.2025.127580
language
English
LU publication?
yes
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Copyright © 2024. Published by Elsevier Ltd.
id
9664fe36-6654-4b50-9cf2-736b9e388e63
date added to LUP
2025-09-22 09:23:14
date last changed
2025-10-21 00:55:49
@article{9664fe36-6654-4b50-9cf2-736b9e388e63,
  abstract     = {{<p>BACKGROUND: There is limited data regarding SARS-CoV-2 vaccine uptake in people with HIV (PWH) compared to people without HIV (PWoH).</p><p>METHODS: 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 &lt;50cells/μL, recent opportunistic disease, or CD4+ T-cells &lt;200 in combination with detectable HIV-RNA &gt; 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.</p><p>RESULTS: 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 &lt; 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).</p><p>CONCLUSIONS: 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.</p>}},
  author       = {{Killander Möller, Isabela and Hedberg, Pontus and Wagner, Philippe and Sparén, Pär and Gisslén, Magnus and Nauclér, Pontus and Aleman, Soo and Bergman, Peter and Carlander, Christina}},
  issn         = {{1873-2518}},
  keywords     = {{Humans; HIV Infections/epidemiology; Sweden/epidemiology; Female; Male; COVID-19 Vaccines/administration & dosage; Middle Aged; COVID-19/prevention & control; Adult; Vaccination/statistics & numerical data; Aged; Sociodemographic Factors; SARS-CoV-2/immunology; Cohort Studies; Young Adult}},
  language     = {{eng}},
  month        = {{08}},
  publisher    = {{Elsevier}},
  series       = {{Vaccine}},
  title        = {{Sociodemographic factors influencing SARS-CoV-2 vaccination uptake in people with and without HIV : Insights from a Swedish Nationwide cohort}},
  url          = {{http://dx.doi.org/10.1016/j.vaccine.2025.127580}},
  doi          = {{10.1016/j.vaccine.2025.127580}},
  volume       = {{62}},
  year         = {{2025}},
}