Risk of Severe Breakthrough COVID-19 Is Low Among Vaccinated Individuals with HIV


Study results show that patients with moderate or severe immune suppression should be considered a priority for additional vaccine doses and risk-reduction strategies.

The risk of severe COVID-19 breakthrough within 28 days of a breakthrough infection was low among vaccinated individuals with HIV and those without HIV, according to the results of a study published in JAMA Network Open.

Additionally, investigators found that individuals with HIV who have moderate or severe immune suppression have a higher risk of severe breakthrough infections and should be considered a priority for additional vaccine doses and risk-reduction strategies.

In the study, individuals adults with HIV who were receiving care and were fully vaccinated between December 11, 2020, and June 30, 2021, were matched with individuals without HIV, by age, ethnicity, race, sex, and when they were fully vaccinated. The individuals included had postvaccination COVID-19 breakthroughs before December 31, 2021.

Data were used from 4 US academic centers and integrated health systems. The cohorts included Kaiser Permanente Mid-Atlantic States, such as the District of Columbia, Maryland, and northern Virginia’ Kaiser Permanente Northern California; University of North Carolina Chapel Hill HIV Clinic; and the Veterans Aging Cohort Study.

Among the 3649 individuals who had breakthrough COVID-19, most were men aged 55 years or older.

Investigators found that the cumulative incidence of severe illness in the first 28 days was comparable and low between both groups, with those who did not have HIV at approximately 7.3% and those with HIV at approximately 6.7%.

Additionally, the risk of severe breakthrough illness was 59% higher in individuals with HIV who had a CD4 cell count less than 350 cells/μL compared with those who do not have HIV.

In a multivariable analysis, among those with HIV, investigators found that being female, being older, having a cancer diagnosis, and having a lower CD4 cell count were associated with increased risk of severe breakthrough illness. They also found that a previous COVID-19 infection was associated with reduced risk.

Among the 249 individuals who were hospitalized, 24 were on mechanical ventilation, and 20 died. There was no difference in whether they had or did not have HIV.

Most hospitalizations occurred on the same day or within 2 days after a COVID-19 diagnosis. The median duration of hospitalization was 5 days for those without HIV and 4 days for those with HIV.

Severe COVID-19 breakthrough was defined as hospitalization within 28 days of breakthrough and a discharge diagnosis that ranks COVID-19 first or second.

Investigators reported that because of the population having a greater proportion of men with HIV than in the general US population with HIV, the findings might not be applicable to all individuals with HIV.


Lang R, Humes E, Coburn SB, et al. Analysis of severe illness after postvaccination COVID-19 breakthrough among adults with and without HIV in the US. JAMA Netw Open. 2022;5(10):e2236397. doi:10.1001/jamanetworkopen.2022.363

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