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Title
COVID-19 vaccine effectiveness by HIV status and injection drug use history
Presenter
Joseph H. Puyat
Authors
J.H. Puyat1,2,3, J. Wilton1, A. Fowokan1, N.Z. Janjua1,2, J. Wong1,2, T. Grennan1,2, C. Chambers4, A. Kroch5, C.T. Costiniuk6, C.L. Cooper7, D. Lauscher8, M. Strong9, A.N. Burchell10,4,11, A. Anis2, H. Samji1,12
Institutions
1British Columbia Centre for Disease Control, Vancouver, Canada, 2University of British Columbia, School of Population and Public Health, Vancouver, Canada, 3Centre for Health Evaluation and Outcome Sciences, St Paul’s Hospital, Vancouver, Canada, 4University of Toronto, Dalla Lana School of Public Health, Toronto, Canada, 5The Ontario HIV Treatment Network, Toronto, Canada, 6McGill University Health Centre, Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, Montreal, Canada, 7University of Ottawa, Department of Medicine, Ottawa, Canada, 8CIHR Canadian HIV Trials Network, Vancouver, Canada, 9PAN, Vancouver, Canada, 10University of Toronto, Department of Family and Community Medicine, Faculty of Medicine, Toronto, Canada, 11St. Michael’s Hospital, Unity Health, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Canada, 12Simon Fraser University, Faculty of Health Sciences, Burnaby, Canada

BACKGROUND: Some evidence suggests that people living with HIV (PLWH) and people who inject drugs (PWID) may experience lower COVID-19 vaccine effectiveness (VE). This lower VE may be due to a direct impact of HIV acquisition / substance use on immune function, and/or an indirect effect via other comorbidities that are common in these populations. Our objective was to assess COVID-19 VE by HIV status and injection drug use (IDU) history.
METHODS: We applied validated algorithms to administrative datasets in the British Columbia COVID-19 Cohort (BCC19C) to create a population-based cohort of PLWH and a matched HIV-negative cohort, and to ascertain history of IDU. We included individuals who received RT-PCR testing for SARS-CoV-2 between Dec 15th, 2020, and Nov 21, 2021. A test-negative study design was used to estimate VE. Analyses were performed using logistic regression with crossed terms for vaccination status, PLWH status and IDU history, adjusting for sociodemographics, calendar time and co-morbidities.
RESULTS: The analysis included 2,700 PLWH and 375,043 matched HIV-negative individuals – of whom 40.7% and 4.3% had a history of IDU, respectively. VE with 2 doses was lower among PLWH with IDU history (65.8%, 95% CI= 43.5%-79.3%) than PLWH without (80.3%, 95% CI= 62.7-89.6), and VE increased slower and decreased more quickly in the former, although confidence intervals were wide. The finding of lower VE among people with IDU history was also present in the HIV-negative cohort but was more pronounced among PLWH.


PLWH
HIV-negative individuals

History of IDU
No history of IDU
History of IDU
No history of IDU
1st dose
44.1 (-25.8-75.2)
-36.5 (22.1-48.2)
56.3 (52.7-59.6)
2nd dose (days)




= 7*
65.8 (43.5 -79.3)
80.3 (62.7-89.6)
82.1 (79.9-84.1)
88.6(88.2- 89.0)
7-59
65.7 (17.9-85.7)
80.3 (50.9-92.1)
87.7 (85.1-89.9)
91.5 (91.1-92.0)
60-89
91.3 (62.3-98.0)
85.9 (56.8-95.4)
83.9 (80.3-86.9)
89.9 (89.4-90.3)
90-119
65.9 (21.6-85.2)
88.1 (63.6-96.1)
79.7 (75.2-83.4)
87.8 (87.2-88.4)
120-179
42.4 (-17.8-71.8)
64.0 (15.7-84.7)
71.8 (65.2-77.1)
84.6 (83.8-85.4)

CONCLUSIONS: PWID may experience lower VE against COVID-19 acquisition, particularly for people who are also living with HIV. These findings highlight the convergence of the dual public health crises and the importance of prioritizing PLWH and PWID for booster doses. The higher prevalence of IDU among PLWH may partly explain our previously published finding of slower buildup / quicker waning among PLWH overall compared to HIV-negative individuals.