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Risk of getting COVID-19 after being vaccinated higher for people with HIV

Hester Phillips

21 December 2021

Evidence from the USA suggests people with HIV who have been fully vaccinated against COVID-19 are more at risk of getting coronavirus than other vaccinated people – although the risk remains low

n older man being vaccinated
Photo credit: iStock/SolStock

What is the research about?

A US study has looked at the risk of breakthrough COVID-19 infections among fully vaccinated people with and without HIV. A breakthrough infection is an infection that happens even though someone has been vaccinated against a disease.

The research involved around 109,500 people, 31,840 of whom had HIV.

The study took place between January and September 2021 when the Delta variant was dominant in the USA.

Being fully vaccinated against COVID-19 was defined as having two doses of the Pfizer or Moderna vaccine or a single dose of the Johnson and Johnson vaccine.

Why is this research important?

Studies like this one are important for understanding whether people with HIV are more at risk of getting COVID-19 even when they have been vaccinated.

Currently, the US recommends that people with advanced or untreated HIV should get a third dose of COVID-19 vaccine, or a booster depending on the type of vaccine they originally received. But this does not apply to people with HIV who are virally suppressed. One of the key things this study looked at is whether extra doses should be provided to all people with HIV, regardless of their health.

What did they find out?

Only 2.3% of people in the study got COVID-19 in the 7 months after being fully vaccinated. But there were more breakthrough infections among people with HIV than other people (2.8% compared to 2.1%).

After taking other factors into account, the risk of a breakthrough COVID infection was 41% higher for people with HIV. This risk was higher whether people with HIV were virally suppressed or not.

The risk of breakthrough infection was highest for people who had received a Johnson and Johnson vaccine (3.3%), followed by Pfizer (2.6%) and Moderna (1.7%). The risk was higher for people with HIV across all vaccine types compared to other people.

What does this mean for HIV services?

As this study took place in the USA it is unclear how applicable it is to other countries. But it does suggest that people with HIV are more likely to get COVID-19 after they get vaccinated than other people. The fact that this risk is low for people with and without HIV shows how effective COVID-19 vaccinations are.

As the risk of a breakthrough COVID infection is higher for people with HIV whether they are virally suppressed or not, third doses or booster jabs should be offered to all people with HIV, regardless of their viral load.

Guidance on COVID-19 vaccines for people with HIV differs between countries. It is important to know what your country’s guidance is and to be aware that all people with HIV may need extra vaccine doses. This is important, as other studies have found that people with HIV have a slightly increased risk of severe illness and death from COVID-19 than other people.

There is a need for more research on breakthrough infections among people with HIV in different countries, particularly as new variants like Omicron emerge, which two vaccine doses appear to be less effective against.

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