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[Preprint]. 2021 Dec 5:2021.12.02.21267182.
doi: 10.1101/2021.12.02.21267182.

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

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

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

Sally B Coburn et al. medRxiv. .

Update in

  • Analysis of Postvaccination Breakthrough COVID-19 Infections Among Adults With HIV in the United States.
    Coburn SB, Humes E, Lang R, Stewart C, Hogan BC, Gebo KA, Napravnik S, Edwards JK, Browne LE, Park LS, Justice AC, Gordon KS, Horberg MA, Certa JM, Watson E, Jefferson CR, Silverberg MJ, Skarbinski J, Leyden WA, Williams CF, Althoff KN; Corona-Infectious-Virus Epidemiology Team (CIVETs) of the NA-ACCORD of IeDEA. Coburn SB, et al. JAMA Netw Open. 2022 Jun 1;5(6):e2215934. doi: 10.1001/jamanetworkopen.2022.15934. JAMA Netw Open. 2022. PMID: 35671054 Free PMC article.

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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Figures

Figure 1:
Figure 1:
Trends in SARS-CoV-2 vaccine breakthrough incidence rates and 95% confidence intervals, by HIV status
Figure 2:
Figure 2:
Cumulative incidence of SARS-CoV-2 vaccine breakthrough (and 95% confidence intervals represented by the shading), stratified by a) HIV status, b) CD4 count and HIV status, and c) HIV viral suppression and HIV status
Figure 2:
Figure 2:
Cumulative incidence of SARS-CoV-2 vaccine breakthrough (and 95% confidence intervals represented by the shading), stratified by a) HIV status, b) CD4 count and HIV status, and c) HIV viral suppression and HIV status
Figure 2:
Figure 2:
Cumulative incidence of SARS-CoV-2 vaccine breakthrough (and 95% confidence intervals represented by the shading), stratified by a) HIV status, b) CD4 count and HIV status, and c) HIV viral suppression and HIV status
Figure 3:
Figure 3:
Cumulative incidence of SARS-CoV-2 vaccine breakthrough infection (and 95% confidence intervals represented by the shading), stratified by HIV status and primary vaccination series type
See this image and copyright information in PMC

References

    1. Polack FP, Thomas SJ, Kitchin N, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med. 2020;383(27):2603–2615. doi:10.1056/nejmoa2034577 - DOI - PMC - PubMed
    1. Baden LR, El Sahly HM, Essink B, et al. Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine. N Engl J Med. 2021;384(5):403–416. doi:10.1056/nejmoa2035389 - DOI - PMC - PubMed
    1. Sadoff J, Gray G, Vandebosch A, et al. Safety and Efficacy of Single-Dose Ad26.COV2.S Vaccine against Covid-19. N Engl J Med. 2021;384(23):2187–2201. doi:10.1056/nejmoa2101544 - DOI - PMC - PubMed
    1. Birhane M, Bressler S, Chang G, et al. COVID-19 Vaccine Breakthrough Infections Reported to CDC — United States, January 1–April 30, 2021. MMWR Morb Mortal Wkly Rep. 2021;70(21):792–793. doi:10.15585/mmwr.mm7021e3 - DOI - PMC - PubMed
    1. Teran RA, Walblay KA, Shane EL, et al. Postvaccination SARS-CoV-2 infections among skilled nursing facility residents and staff members — Chicago, Illinois, December 2020–March 2021. Am J Transplant. 2021;21(6):2290–2297. doi:10.1111/ajt.16634 - DOI - PMC - PubMed

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