Improved Meningococcal Vaccine Guidance Needed for Patients With HIV

Receipt of the meningococcal A, C, W, Y (MenACWY) vaccine was poor among individuals with newly diagnosed HIV infection at increased risk for meningococcal disease, indicating a need for better education on vaccination recommendations among this population. These findings were published in JAMA Network Open.

This nationwide cohort study conducted in the US used data captured from the Optum Research Database between January 2016 and March 2018. Eligible participants included those with either at least 1 inpatient or 2 or more outpatient claims for newly diagnosed HIV infection. In addition, all participants were aged 2 years and older and had continuous insurance coverage for at least 12 months prior to and 6 or more months following their diagnosis.

The coprimary outcomes were estimated vaccine uptake and the time between HIV diagnosis and receipt of at least 1 dose of the 2-dose MenACWY vaccine. The follow-up period ranged from 6 to 33 months.

Among a total of 1208 participants included in the primary analysis, the mean age was 38.8 years, 84.8% were men, and 36.6% were White.

At 12, 18, and 24 months after their initial HIV diagnosis, 10.6%, 12.9%, and 16.3% of participants, respectively, were estimated to have received at least 1 dose of the MenACWY vaccine. Of 71 participants who received the first vaccine dose and had at least 1 year of available follow-up data, 66.2% were estimated to have received a second dose within the following year.

Multivariable Cox regression analysis showed statistically significant factors associated with increased uptake of the MenACWY vaccine. These included prior pneumococcal vaccination (hazard ratio [HR], 23.03; 95% CI, 13.93-38.09), attendance at a well-care visit (HR, 3.67; 95% CI, 1.11-12.12), male sex (HR, 2.72; 95% CI, 1.18-6.26), and residing in the West (HR, 2.24; 95% CI, 1.44-3.47) or Midwest (HR, 1.78; 95% CI, 1.16-2.71). Further analysis showed that uptake of the MenACWY vaccine was statistically significantly decreased among participants aged 56 years and older (HR, 0.42; 95% CI, 0.18-0.97), as well as those who visited an emergency department at baseline (HR, 0.54; 95% CI, 0.37-0.79).

Limitations included that study enrollment began prior to the release of official guidance recommending the MenACWY vaccine for individuals with HIV infection. Other limitations were potential survivor bias, and that outcomes of mortality and meningococcal disease diagnosis were not assessed.

According to the researchers, “… poor uptake of the MenACWY vaccine among people with a new diagnosis of HIV underscores the need for education about vaccination recommendations for patients at increased risk [for] meningococcal disease.”

Disclosure: This research was supported by GlaxoSmithKline Biologicals SA. Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Ghaswalla PK, Marshall GS, Bengtson LGS, et al. Meningococcal vaccination rates among people with a new diagnosis of HIV infection in the US. JAMA Netw Open. 2022;5(4):e228573. doi:10.1001/jamanetworkopen.2022.8573