- Current WHO recommended COVID vaccines are safe for people living with HIV
- All people living with HIV should be prioritized for early vaccination: WHO
- On hospitalisation, PLHIV have a 30% increased risk of COVID death: WHO
New Delhi: “People living with HIV have an increased risk for severe disease from COVID as well as hospitalisation. And then once hospitalised, have a 30 per cent increased risk of death”, said Dr Meg Doherty, WHO Director HIV, Hepatitis and STI Programmes, as part of World Health Organisation’s Science in 5 series. But why are people living with HIV at an increased risk for severe disease from COVID? Can HIV positive people take the COVID-19 vaccine? Are current COVID vaccines safe for HIV patients? WHO official and other experts explain the link between COVID-19 and HIV.
COVID-19 And The Risk It Poses To People Living With HIV
A new WHO report released earlier in July confirmed that HIV infection is a significant independent risk factor for both severe or critical COVID-19 presentation at hospital admission and in-hospital mortality. Overall, nearly a quarter (23.1 per cent) of all people living with HIV who were hospitalised with COVID-19, died. The report is based on clinical surveillance data from 37 countries regarding the risk of poor COVID-19 outcomes in PLHIV admitted to the hospital for COVID-19.
Underlying conditions such as diabetes and hypertension are common among PLHIV. Among male PLHIV over the age of 65 years, diabetes and hypertension were associated with an increased risk of more severe and fatal COVID-19. These conditions are known to put people at increased risk of severe disease and death, stated WHO while sharing the findings of the report.
Explaining why people living with HIV (PLHIV) may have a worse COVID-19 infection, Dr Monalisa Sahu, Consultant Infectious Diseases, Yashoda Hospitals, Hyderabad, said,
It could be due to the presence of immune dysregulation, higher prevalence of medical comorbidities and presence of an aging population.
Talking more about the high COVID risk among PLHIV, Dr Mala Kaneria, Consultant Department of Infectious Diseases, Jaslok Hospital, Mumbai, said,
People living with HIV are prone to severe COVID illness, if infected. This is particularly so in those with advanced AIDS and lower CD4 counts. The fact that COVID causes lymphocytopenia (a disorder in which your blood doesn’t have enough white blood cells called lymphocytes) just like HIV, makes this co-infected population vulnerable to flaring up of latent infections, which can contribute to the mortality. Also, the radiological appearance of many opportunistic infections in HIV, is mimicked by COVID, thus delaying the diagnosis of either infection.
To control HIV infection, a treatment called antiretroviral therapy (ART) that involves taking a combination of HIV medicines is recommended. However, during the COVID pandemic, a reduction in access to prevention and testing services for HIV was reported, said Dr Doherty and added,
These kinds of services are the ones that we need to restart and maintain so that all people living with HIV have access to the antiretrovirals they need, they find out if they are living with HIV and also now start to be prioritised and have access to COVID-19 vaccines.
Are COVID-19 Vaccines Safe For People Living With HIV?
According to WHO, many of the COVID-19 vaccines studies have included a small number of people living with HIV in their trials. Despite limited data, available information suggests current WHO recommended COVID-19 vaccines (AstraZeneca/Oxford, Johnson and Johnson, Moderna, Pfizer/BionTech, Sinopharm and Sinovac) are safe for people living with HIV.
The currently available vaccine products are not live vaccines, they include genetic material from SARS-CoV-2 which cannot replicate. Therefore, these vaccines are not expected to be less safe in people who are immunocompromised. In addition to this, no pharmacological interactions have been reported between COVID-19 vaccines and antiretroviral medications which people living with HIV should continue to take after vaccination to maintain health, states WHO.
Echoing the same, Dr Sahu said, currently available COVID-19 vaccines in India are believed to be safe for most people, including the population living with HIV. These vaccines have the same benefits in the PLHIV, as that in the other individuals, as prevention of severe disease and potentially reduced transmission of the SARS-CoV-2, she said.
In PLHIV, CD4 count that measures the robustness of the immune system is used to see how well a person is responding to medication. An increase or decrease in CD4 count depicts the improvement and progression in the infection. Dr Doherty said that there are some concerns that some of the newer generation vaccines may not be as effective in those who have very low CD4 counts, people who are not on treatment or have immunosuppression.
But certainly, that data is not clear yet. And we have to follow this forward as we learn more about some of the clinical trials that are happening in South Africa for some of these newer generation vaccines. And we would be very encouraging of people living with HIV to access those vaccines and not to have any differentiation in terms of whether or not they have a low CD4, high CD4 or suppress viral load or not. All should be in line for vaccines, said Dr Doherty.
The WHO expert also informed that the organisation will be looking forward to knowing whether people living with HIV might need a booster shot in the future. But, right now, the aim is to get everyone vaccinated.
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