Routine Vaccination During Pregnancy Among People Living With HIV in the United States

IMPORTANCE Pregnancy represents a window of opportunity for vaccination due to establishedmaternal and fetal benefits of vaccination. Little is known about receipt of routinely recommendedvaccines in pregnancy, specifically tetanus, diphtheria, plus acellular pertussis (Tdap) and influenza,among pregnant people living with HIV (PLHIV). OBJECTIVE To estimate prevalence of vaccination receipt among pregnant people with HIV (PLHIV)and identify demographic and clinical characteristics associated with vaccination. DESIGN, SETTING, AND PARTICIPANTSThis multicenter cohort study included womenparticipating in Women's Health Study (WHS) of the Surveillance Monitoring for ART Toxicities(SMARTT) Study of the Pediatric HIV/AIDS Cohort Study. The network has been enrolling pregnantPLHIV at 22 US sites since 2007. Participants for this study enrolled between December 2017 andJuly 2019. Data analysis was conducted from October 2021 to March 2022. EXPOSURE Data on vaccination in pregnancy were collected through medical record abstraction. MAIN OUTCOMES AND MEASURESVaccination receipt was defined as Tdap vaccination receivedat less than 36 weeks' gestation and influenza vaccination at any gestational age, based on currentguidelines. Log-binomial and modified Poisson regression models with generalized estimatingequations were fit to identify factors associated with successful receipt of (1) Tdap, (2) influenza, and(3) both vaccinations. RESULTS A total of 310 pregnancies among 278 people participating in the WHS were included(mean [SD] age, 29.5 [6.1] years; 220 [71%] Black, 77 [25%] Hispanic, and 77 [25%] race and ethnicityother than Black; 64 [21%] with perinatally acquired HIV). Less than one-third of pregnancies werevaccinated as recommended (Tdap, 32.6% [95% CI, 27.4%-38.1%]; influenza, 31.6% [95% CI, 26.5%-37.1%]; both, 22.6% [95% CI, 18.0%-27.6%]). People living with perinatally acquired HIV, those whodid not identify as Black, or those who were multiparous had adjusted risk ratios (aRRs) less than 1,while older PLHIV had aRRs greater than 1, but these differences did not reach statistical significance(perinatally acquired HIV: adjusted risk ratio [aRR], 0.46; 95% CI, 0.21-1.02; race other than Black:aRR, 0.53; 95% CI, 0.26-1.08; multiparous: aRR, 0.59; 95% CI, 0.35-1.00; age 24-29 years: aRR, 2.03;95% CI, 0.92-4.48). CONCLUSIONS AND RELEVANCEIn this diverse, multicenter cohort of pregnant PLHIV, receipt ofrecommended vaccinations was low. Identifying and addressing barriers to vaccination receipt isurgently needed for pregnant people with HIV.