New Research Reveals Those With HIV More Susceptible to Breakthrough COVID Cases

A new study finds that fully vaccinated people in the U.S.with HIV have a significantly higher risk of COVID-19 breakthrough infections than people without HIV.

The study, published in early June in the JAMA Network Open, examined a cohort of 113 994 patients, and found that while the risk of breakthrough infection was low overall with just 3.8 percent, it was 28 percent higher in those with HIV.

“The higher rate and risk of infection in people with HIV observed in this study suggests comprehensive inclusion of this population in recommendations for additional primary doses in immunocompromised groups,” revealed study author Sally B. Coburn, Ph.D., M.P.H., department of epidemiology for Johns Hopkins Bloomberg School of Public Health.

Researchers in the study compared the risk of breakthrough infection by HIV status using Cox proportional hazard models to better estimate unadjusted hazard ratios (HRs) and adjusted hazard ratios (aHRs).

“We adjusted for cohort as a surrogate for sociodemographic and regional differences in COVID-19 transmission rates, vaccine rollout, COVID-19 testing protocols, and access to care,” the study authors said. “An interaction term with calendar period was included due to nonproportional hazards by history of COVID-19 and improved model fit.”

From there, CD4 count and suppressed viral load were assessed as risk factors for breakthrough infection.

The findings showed that COVID-19 vaccination, especially with a booster dose, was effective against infection with SARS-CoV-2 strains circulating through December 31, 2021 but people with HIV had an increased risk of breakthrough infections compared with those without.

While the CDC currently recommends those with untreated or advanced HIV receive an additional dose 28 days or more after the second mRNA dose and a booster three months or more for mRNA or two months or more for those initially vaccinated with Ad26.COV2.S dose, the authors argue that all people with HIV would benefit from being included in this recommendation.

The risk of breakthrough was higher in people living with HIV regardless of CD4 count or HIV viral suppression, according to the findings reported by Coburn and her colleagues.

“A first booster dose is now recommended for those aged 12 years and older, and a second booster is recommended for those aged 50 years and older and certain immunocompromised groups; our findings suggest these booster doses may be even more important for all people with HIV to prevent breakthrough infections,” the authors wrote, noting further research is required to study this potential association.

“Ultimately, policy makers must determine the appropriate balance between preventing further COVID-19 infections and possibly unnecessary additional vaccinations,” the study concluded. “Increased risk of breakthrough infections in PWH merits continued monitoring as the pandemic persists, immunity to primary vaccine series wanes, boosters are widely recommended, and new variants emerge.”