COVID-19 infections post-vaccination by HIV status in the United States

  1. Sally B. Coburn
  2. Elizabeth Humes
  3. Raynell Lang
  4. Cameron Stewart
  5. Brenna C Hogan
  6. Kelly A. Gebo
  7. Sonia Napravnik
  8. Jessie K. Edwards
  9. Lindsay E. Browne
  10. Lesley S. Park
  11. Amy C. Justice
  12. Kirsha Gordon
  13. Michael A. Horberg
  14. Julia M. Certa
  15. Eric Watson
  16. Celeena R Jefferson
  17. Michael Silverberg
  18. Jacek Skarbinski
  19. Wendy A Leyden
  20. Carolyn F. Williams
  21. Keri N. Althoff
  22. for the Corona-Infectious-Virus Epidemiology Team (CIVETs) of the NA-ACCORD of IeDEA
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Abstract

Importance

Recommendations for additional doses of COVID vaccine are restricted to people with HIV who have advanced disease or unsuppressed HIV viral load. Understanding SARS-CoV-2 infection risk post-vaccination among PWH is essential for informing vaccination guidelines.

Objective

Estimate the risk of breakthrough infections among fully vaccinated people with (PWH) and without (PWoH) HIV in the US.

Design, setting, and participants

The Corona-Infectious-Virus Epidemiology Team (CIVET)-II cohort collaboration consists of 4 longitudinal cohorts from integrated health systems and academic health centers. Each cohort identified individuals ≥18 years old, in-care, and fully vaccinated for COVID-19 through 30 June 2021. PWH were matched to PWoH on date fully vaccinated, age group, race/ethnicity, and sex at birth. Incidence rates per 1,000 person-years and cumulative incidence of breakthrough infections with 95% confidence intervals ([,]) were estimated by HIV status. Cox proportional hazards models estimated adjusted hazard ratios (aHR) of breakthrough infections by HIV status adjusting for demographic factors, prior COVID-19 illness, vaccine type (BNT162b2, [Pfizer], mRNA-1273 [Moderna], Jansen Ad26.COV2.S [J&J]), calendar time, and cohort. Risk factors for breakthroughs among PWH, were also investigated.

Exposure

HIV infection

Outcome

COVID-19 breakthrough infections, defined as laboratory evidence of SARS-CoV-2 infection or COVID-19 diagnosis after an individual was fully vaccinated.

Results

Among 109,599 individuals (31,840 PWH and 77,759 PWoH), the rate of breakthrough infections was higher in PWH versus PWoH: 44 [41, 48] vs. 31 [29, 33] per 1,000 person-years. Cumulative incidence at 210 days after date fully vaccinated was low, albeit higher in PWH versus PWoH overall (2.8% versus 2.1%, log-rank p<0.001, risk difference=0.7% [0.4%, 1.0%]) and within each vaccine type. Breakthrough infection risk was 41% higher in PWH versus PWoH (aHR=1.41 [1.28, 1.56]). Among PWH, younger age (18-24 versus 45-54), history of COVID-19 prior to fully vaccinated date, and J&J vaccination (versus Pfizer) were associated with increased risk of breakthroughs. There was no association of breakthrough with HIV viral load suppression or CD4 count among PWH.

Conclusions and Relevance

COVID-19 vaccination is effective against infection with SARS-CoV-2 strains circulating through 30 Sept 2021. PWH have an increased risk of breakthrough infections compared to PWoH. Recommendations for additional vaccine doses should be expanded to all PWH.

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