NIH: People with HIV should be prioritized for COVID-19 vaccination
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The NIH said people with HIV should be considered a high-risk group when making decisions about COVID-19 vaccine priority. The recommendation was part of the NIH’s updated interim guidance for COVID-19 and HIV.
Previous research has shown that HIV increases the risk for death or poorer outcomes from COVID-19, whereas other studies have suggested that HIV does not affect outcomes or the risk for hospitalization from COVID-19.
To address these concerns, physicians previously launched the Coronavirus Under Research Exclusion (CURE) registry for physicians — a database containing information on COVID-19 cases among patients with HIV.
“As we get more data from specific chart studies, and even from prospective studies of individuals with HIV, we will begin to identify the absolute risk much more clearly,” Jack A. DeHovitz, MD, MPH, MHCDS, FACP, a distinguished service professor and director of the HIV Center for Women and Children at the State University of New York Downstate Health Sciences University, told Healio.
“The existing administrative data studies and observational studies certainly suggest that morbidity and mortality can be higher in people with HIV,” DeHovitz said.
For all people living with HIV, the NIH recommends:
- CDC’s SARS-CoV-2 prevention measures, like social distancing and mask wearing, are followed;
- they receive SARS-CoV-2 vaccines regardless of CD4 count or viral load;
- pregnant or lactating individuals who meet criteria for vaccination should not be restricted from vaccine access;
- pneumococcal and influenza vaccination need to be kept up to date. The COVID-19 vaccine should not be given within 2 weeks of another vaccine and;
- overall, people living with HIV with COVID-19 should receive the same clinical management and medical triage care as the general population.
For the management of COVID-19 in patients with HIV, the NIH recommends:
- the same considerations as the general population for triage, management and treatment of COVID-19;
- HIV-associated opportunistic infections should be weighed during diagnosis of febrile illness in people with advanced HIV;
- clinicians should pay attention to drug-drug interactions and overlapping toxicities in COVID-19 treatments, antiretroviral medications, antimicrobial therapies and other medications and;
- people with HIV should be offered the chance to take part in clinical vaccine trials or potential treatment studies for SARS-CoV-2.
DeHovitz said it is important that clinicians be aware of new HIV and COVID-19 research, and "educate their patients as well as encourage them to come in for vaccination."
References:
- HIV.gov. Guidance for COVID-19 and people with HIV. https://clinicalinfo.hiv.gov/en/guidelines/covid-19-and-persons-hiv-interim-guidance/interim-guidance-covid-19-and-persons-hiv/. Accessed February 2, 2021.
- NIH. Special considerations in people with human immunodeficiency virus. https://www.covid19treatmentguidelines.nih.gov/special-populations/hiv/. Accessed February 2, 2021.
Perspective
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This is certainly a welcome update to the realm of COVID-19 vaccines in our vulnerable HIV population. Traditionally, the HIV population, in the setting of its immunocompromise, has been by and large excluded from clinical trials, including vaccine trials. Ironically, that is the very population that we must seek to protect, among others, especially in the context of their impaired immune systems. Although trials studying the COVID-19 vaccines have included people with HIV, these are in relatively small numbers and further duration of follow-up, and more data are awaited. However, given that the vaccines available thus far are not live virus vaccines, this appears less likely to pose a safety concern to HIV patients. Despite the possibility of a weaker immune response to the vaccine, any amount of protection that may be afforded by vaccine administration during this pandemic would be a win — with potential benefits outweighing the potential risks. I applaud this much-needed and encouraging guidance advocating for our HIV patient population.
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HIV.gov. Guidance for COVID-19 and people with HIV. https://clinicalinfo.hiv.gov/en/guidelines/covid-19-and-persons-hiv-interim-guidance/interim-guidance-covid-19-and-persons-hiv/. Accessed February 2, 2021.
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