HIV-Specific vs Universal Immunization Coverage in US Children with HIV: A Multi-Site Study

Immunization recommendations for children living with HIV (CLWH) differ from the general pediatric population due to increased risk of vaccine-preventable diseases. Adherence to these specific recommendations remains understudied in the United States. We assessed HIV-specific versus universal immunization coverage across multiple pediatric HIV clinics.

We conducted a retrospective, cross-sectional study of CLWH (0-18 years) receiving HIV care as of May 1, 2021, at 6 US pediatric HIV clinics. We evaluated coverage for universal and HIV-specific vaccines, including those that may require additional doses for CLWH. Associations between vaccine coverage and demographic factors, as well as HIV-related factors, were assessed using inferential statistics and prevalence ratios (PR).

Among the 238 CLWH, coverage for HIV-specific vaccines was lower than universal vaccines. PPSV23 had the lowest coverage (25.7%), followed by MenACWY (46.2%), compared to universal vaccine coverages of 74.0%-91.8%, except rotavirus. For PPSV23, 7-12 years age group was almost one-fifth as likely to be up-to-date compared to 0-6 years (PR 0.19, 95% CI, 0.09-0.43) while those receiving primary care at an HIV clinic were more likely to be up-to-date (PR 4.11, 95% CI, 2.58-6.55). For MenACWY, those receiving primary care at an HIV clinic (PR 1.97, 95% CI, 1.53-2.53) or having Medicaid (PR 1.58, 95% CI, 1.19-2.11) were more likely to be up-to-date.

Significant gaps exist in adherence to HIV-specific immunization recommendations. Targeted interventions, including integrated HIV and primary care services and enhanced clinical decision support systems, may improve coverage for CLWH.