Postvaccination COVID-19 Among Persons with HIV in the U.S.

SARS-CoV-2 infection after vaccination (i.e., breakthrough infection) is not uncommon, but little is known about its frequency in persons with HIV (PWH). To determine if HIV status is associated with excess risk for COVID-19 breakthrough infection among fully vaccinated PWH, investigators studied four cohorts seen at U.S. integrated health systems or academic centers through December 2021 and matched each PWH to three persons without HIV (PWoH) by vaccination date. Approximately 114,000 participants (33,000 PWH and 81,000 PWoH) were included (92% male, 70% aged ≥55, 41% non-Hispanic Black). Vaccines were BNT162 (51%), mRNA-1273 (42%), and Ad26.COV2.5 (7%). At vaccination, PWH had median CD4 of 636 cells/µL and were virally suppressed (91%). PWH were more likely than PWoH to receive a booster dose (56% vs. 45%).

Incidence of breakthrough infections was 47 cases per 1000 person-years overall and was higher for PWH (55 cases) than for PWoH (43 cases). Regardless of vaccine type, likelihood of breakthrough infection was higher in PWH. Among PWH, those with CD4 counts ≥500 cells/µL had lower risk for breakthrough infection — and those with prior COVID-19 had two-fold higher risk. Receiving a booster dose was associated with lower risk for breakthrough infection.