HIV patients at high risk of COVID breakthrough infection

According to a study by the Coronavirus Epidemiology Team (CIVET) -II cohort, HIV patients who were completely vaccinated against COVID-19 were more likely to develop breakthrough infections.

Of the approximately 114,000 fully vaccinated patients, HIV-infected patients had a 28% increased risk of breakthrough infections compared to non-HIV-infected patients (adjusted hazard ratio). [aHR] 1.28, 95% CI 1.19-1.37), 55:43 cases per 1,000 person-years, reported by Dr. Kelly Althof, MPH, and colleagues at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

The cumulative incidence of breakthrough infections was low 9 months after vaccination (3.8%), suggesting a strong protective effect, but was greater in people with HIV than in people without HIV (4.4%). Vaccine against 3.5% P<0.001), regardless of the type of vaccine, the author writes: JAMA network open..

“These findings warn all people infected with HIV that they are at high risk of a breakthrough in COVID-19, and official recommendations for COVID-19 vaccination for people infected with HIV. We can let you know, “says Althoff. Today’s MedPage..

Overall, the risk of breakthrough infections was highest with the Johnson & Johnson vaccine (5.7%), followed by the Pfizer-BioNTech (4.4%) and Moderna vaccine (2.8%).

Certain factors were associated with this great risk, such as young age (≤44) and not receiving additional vaccines. In addition, a history of COVID-19 almost doubled the risk (aHR 1.96, 95% CI 1.65-2.33).

Breakthrough infections Usefulness of vaccine, Altov’s group pointed out.However, in previous reports Consistently does not show greater risk Percentage of breakthrough infections in HIV patients.

“Currently, CDC includes untreated or advanced (ie, CD4 <200 cells / mm) people.³) HIV in the definition of people with “moderate or severe immunodeficiency” Primary series of additional vaccine doses, In addition to boosters, Altov said, “Our findings suggest that HIV-infected individuals who do not meet these criteria may also benefit from the primary series of additional vaccines.” Stated.

“The policy makers who establish the guidelines will consider the benefits and risks of additional doses of the primary series of vaccines not only for severe or untreated HIV patients, but also for moderately immunosuppressed patients or all HIV-infected individuals. Must be “to co-John’s Hopkins Bloomberg School of Public Health Dr. Sally Coburn, MPH, press release..

For this study, Althoff et al., 113,994 adults (33,029 with HIV and 33,029 with HIV) who were completely vaccinated against COVID-19 with the approved vaccine (two mRNA vaccines or one Johnson & Johnson vaccine). We examined the data of 80,965 people without HIV). Before June 30, 2021. This group used the CIVETII cohort. This includes four future electronic health record-based cohorts from the Integrative Medicine System and Academic Medical Centers.

Follow-up continued until December 2021. The authors authored demographics, primary vaccine series types, timing of third dose, and COVID-19 history and 3-month calendar period (January-March, April-June, July-July). ) Interactions have been adjusted. September, and October-December).

Almost all patients were male, 70% were 55 years or older, 41% were black, and 38% were white. Most were vaccinated with mRNA (93%). A quarter of HIV patients had a history of AIDS prior to vaccination, but most (91%) reached virus suppression when fully vaccinated.

Althoff et al. Found that older patients (aged 55 and older) had a lower risk of breakthrough infections. This suggests that it may be due to behavioral changes such as the adoption of masking and the expansion of social distance.

In particular, the number of CD4 is high (500 vs. <200 cells / mm)³ ) It was associated with a reduction in breakthrough infections in HIV patients (aHR 0.66, 95% CI 0.50-0.88). No association was found with HIV virus suppression.

The authors acknowledged that their findings may not be generalized to all HIV patients or patients without regular medical access. In addition, comorbidities are not considered and may affect the risk of breakthrough infections. The studies were conducted during the circulation of alpha, delta, and omicron variants, they said.