People living with HIV are at higher risk of breakthrough infections with COVID-19 after vaccination

People with HIV have higher rates of breakthrough COVID-19 infection after vaccination compared to people without HIV, according to results of a study led by researchers at the Johns Hopkins Bloomberg School of Public Health.

In the study, researchers analyzed anonymized medical records from nearly 114,000 people who were fully vaccinated from June 30, 2021 to December 31, 2021 with either two doses of mRNA vaccines or one dose of the J&J viral vector vaccine. Comparing vaccine recipients with and without HIV, the researchers found that the likelihood of a positive SARS-CoV-2 test result or a COVID-19 diagnosis within nine months of full vaccination, while low, increased by 28 percent in people with HIV was higher. The risk of breakthrough infection was 3.8 percent for the non-HIV group and 4.4 percent for the HIV group in the period examined.

The results will be published on June 7th JAMA network open.

These results should alert all people living with HIV to their greater risk of COVID-19 breakthrough and may provide official recommendations on COVID-19 vaccination for people living with HIV.”

Keri Althoff, PhD, senior study author, associate professor, Department of Epidemiology, Bloomberg School

Since the pandemic began, public health officials have raised concerns about a possible increased risk of COVID-19 in people with compromised immune systems, including people living with HIV. The Centers for Disease Control and Prevention currently recommends that people who are “moderately or severely immunocompromised” — a category that includes people with HIV who are untreated or have a low CD4 T-cell count (< 200 cells per microliter). -, receive an additional dose of the vaccine as part of their primary vaccination course, followed by a booster dose. Studies to date have generated relatively little data on vaccination outcomes for people living with HIV.

For their study, Althoff and her colleagues pooled individual-level data from four U.S. health systems to create a study population called the Corona-Infectious-Virus Epidemiology Team (CIVET) cohort. The CIVET cohort includes anonymized records from private health insurance companies, the Veterans Affairs Health Care System, and an academically affiliated health care system. Patients in the study population were treated for various medical conditions prior to the COVID-19 pandemic. Researchers looked at the records of 113,994 people who had been fully vaccinated by June 30, 2021. Matching the 33,029 HIV-positive patients in the sample with the 80,965 HIV-negative patients (by age, race, gender and date of complete vaccination), they compared the rates of breakthrough SARS-CoV-2 infections in the two groups during the first nine months after vaccination or by December 31, 2021, whichever came first.

The breakthrough rates — 3.8 percent for the non-HIV group and 4.4 percent for the HIV group — are much lower than the COVID-19 rate in unvaccinated individuals, suggesting a strong protective effect of vaccination. However, the analysis showed that the overall risk of breakthrough infection was 28 percent higher for the HIV group compared to the non-HIV group after adjusting for between-group differences.

In addition, the study found an increasing risk of breakthrough with increasing immunosuppression, measured by decreasing CD4 counts. Those with CD4 counts, which signal moderate immunosuppression in people living with HIV, range from 200 to 350 cells/mm3 Range – had a statistically significant increase in breakthrough risk compared to people without HIV. That suggests, Althoff says, that people living with HIV and moderately immunosuppressed may need to be included in CDC guidelines for additional vaccine doses in the primary series.

“Policymakers setting the guidelines should consider the benefits and risks of adding a dose of vaccine to the primary immunization program not only for those with severe or untreated HIV, but also for those with moderate immunosuppression or even all people with HIV,” the study said First author Sally Coburn PhD, postdoctoral researcher in the Department of Epidemiology, Bloomberg School.

Althoff and colleagues are conducting a study to determine whether vaccinated people with HIV not only have higher breakthrough infection rates, but also higher post-breakthrough hospitalization rates.


Johns Hopkins University Bloomberg School of Public Health

Magazine reference:

Coburn, SB, et al. (2022) Analysis of post-vaccination breakthrough COVID-19 infections in adults living with HIV in the United States. JAMA network open.

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