The risk of COVID-19 infection after primary vaccination was 28% higher in adults diagnosed as having HIV, suggesting they may benefit from two additional doses, according to a US study published yesterday in JAMA Network Open.Johns Hopkins University researchers led a team assessing the risk of COVID-19 infection among 113,994 vaccinated patients—33,029 of whom had HIV and 80,965 who didn't—through Dec 31, 2021.Participants were part of the Corona-Infectious-Virus Epidemiology Team (CIVET)-II cohort and were seen at Kaiser Permanente Mid-Atlantic States, Kaiser Permanente Northern California, the University of North Carolina Chapel Hill HIV Clinic, and the Veterans Aging Cohort Study (VACS) sites.Participants had received either two doses of an mRNA COVID-19 vaccine (Pfizer/BioNTech or Moderna; 93%) or one dose of the Johnson & Johnson (J&J) vaccine (7%) at least 14 days earlier, by Jun 30, 2021.
Most participants (70%) were 55 years or older and men (92%); 41% were Black, and 38% were White. The study period spanned weeks in which the Delta and Omicron variants were predominant.Younger age, lack of extra dose tied to higher riskAfter adjusting for between-group differences, the overall risk of COVID-19 infection was low (3.8%) but was 28% higher (4.4%) in participants with versus without HIV (55 vs 43 cases per 1,000 person-years; risk difference, 0.9%) and within each vaccine type.Among participants with HIV, younger age (younger than 45 vs 45 to 54 years) and non-receipt of an additional vaccine dose (adjusted hazard ratio, 0.71) were linked to an elevated risk of post-vaccination infection.The rate of post-vaccination infection was highest in J&J vaccine recipients (5.7%), followed by Pfizer (4.4%), and Moderna