HIV and Covid-19 Breakthrough Infections

By: Ranier Simons, ADAP Blog Guest Contributor

Presently, there is a world-wide surge in Covid-19 infections. This surge not only includes unvaccinated people, but partially and fully vaccinated people as well. The Omicron variant, specifically, has proven to be responsible for a sizable spike in infections here in the United States. Constantly evolving research shows that Omicron embodies some ability to evade both protections from vaccination as well as natural immunity from previous Covid-19 infection.[1] Given that there has been an increase in breakthrough Covid-19 cases regardless of vaccination type, what are the implications for people who are fully vaccinated and living with HIV?

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Developing data is showing that people with decreased immune function are at increased risk for Covid-19 breakthrough infection. One such study, by Sun et. al, specifically shows that people living with HIV, people on immunosuppressive drugs due to solid organ transplantation, and people with rheumatoid arthritis are at increased risk for breakthrough infection compared to those without any sort of compromised immune status.[2]

Examination of breakthrough Covid-19 infections, specifically, in the HIV-positive population is in an early stage. Thus, a large amount of data does not exist. However, there have been a few early studies that have given insight.

When discussing breakthrough Covid-19 cases it is important to define the lens of inquiry. Two major lanes of discourse are: discussions of the incidence of breakthrough cases and discussions of actual hospitalizations due to breakthrough cases. 

MedRxiv, the preprint server for health sciences, reports a longitudinal study regarding incidence of breakthrough cases. MedRxiv reports new medical research that has not yet been peer reviewed. Even though the study is not yet ready to be used in evidence-based practice, it still has great value.

The study, conducted by Coburn et. al, was done on a population of 109,599 subjects.[3] The subjects were selected from the Corona-Infectious-Virus Epidemiology Team (CIVET)-II cohort. This cohort consists of four different cohorts with subjects sourced from networked health systems and academic health centers. The purpose of the study was to compare breakthrough infections between those with HIV and those without. There were 31,840 people living with HIV and 77,759 that did not have HIV. The measured incidence of infection was taken 210 days after full vaccination.

The rate of breakthrough infection of fully vaccinated people is very small in relation to the number of people in the United States who are fully vaccinated. However, the study did conclude that the patients with HIV had a higher likelihood of breakthrough infection than those without HIV. The cumulative incidence was 2.8 percent and 2.1 percent, respectively. Additionally, the breakthrough infection risk was 41 percent higher in people living with HIV.

While this study population is not representative of the entire HIV-positive population of the country, there still is value in the result. Most importantly, the study did not find that there was a statistically significant difference in the breakthrough incidence of those with viral suppression compared with those with elevated viral loads or advanced HIV disease.

Along with incidence of breakthrough infection, it is important to explore actual hospitalizations due to breakthrough infections. Again, there currently is not a plethora of data specifically pinpointing hospitalization of HIV-positive individuals due to breakthrough infection. However, there is developing research that indicates hospitalizations as a result of breakthrough infections are more likely in people with co-morbidities.

It is complicated to research hospitalizations due to breakthrough infections because it hard to determine if a hospitalization is solely due to vaccine breakthrough or is due to another issue concurrent with the vaccine breakthrough infection. One promising analysis has shown that fully vaccinated people hospitalized with Covid-19 infections were more likely to be hospitalized because of other issues.[4]

Photo Source: Daily Maverick

Lo et. al analyzed data of 120,000 covid hospitalizations from Cosmos. Cosmos is a HIPPA-defined Limited Data Set of over 120 million patients. The data is medical record data from hundreds of hospitals and organizations that utilize EPIC electronic medical record system software.

The analysis compared Covid-19 breakthrough hospitalizations with unvaccinated Covid-19 hospitalizations. The purpose was to see if the two different groups were being treated for the same things. Common covid-related complication treatments include things like viral pneumonia diagnosis, dexamethasone treatment, respiratory failure diagnosis, and ventilator treatment.[5] The result of the analysis was that fewer people with breakthrough Covid-19 diagnosis had one or more of these complications as compared to the unvaccinated Covid-19 hospitalized patients. It was gleaned that the breakthrough Covid-19 hospitalizations were do more to primary diagnoses other than Covid-19.

The overall theme of all the ongoing scientific research is that while HIV-positive people have increased risk of breakthrough infections, vaccination is still extremely important and drastically reduces the likelihood of serious illness or death due to Covid-19. Seropositive individuals should get vaccinated as well as continue wearing effective masks and practicing all other precautions such as hand sanitation and other preventative measures. Vaccinated HIV-positive people should not be excessively fearful of breakthrough infections, just cautious and responsible in their behaviors and self care.

[1] Kupferschmidt, K., Vogel, G. How bad is Omicron? Some clues are emerging. Science, 374(6573), 1304-1305. https://doi.org/10.1126/science.acx9789
[2] Sally B Coburn, et al. (2021). COVID-19 infections post-1 vaccination by HIV status in the United States. medRxiv. doi: https://doi.org/10.1101/2021.12.02.21267182
[3] Sun, J. et. al. (2021). Association between immune dysfunction and COVID-19 breakthrough infection after SARS-CoV-2 Vaccination in the US. JAMA Intern Med. Published online December 28, 2021. doi:10.1001/jamainternmed.2021.7024
[4] Lo, J., Amin, K., Cotliar, D., Rae, M, Cox, C. (2021, Dec 15) Covid-19 breakthrough hospitalizations. Retrieved from https://www.healthsystemtracker.org/brief/characteristics-of-vaccinated-patients-hospitalized-with-covid-19-breakthrough-infections/
[5] Yek C, Warner S, Wiltz JL, et al. Risk Factors for Severe COVID-19 Outcomes Among Persons Aged ≥18 Years Who Completed a Primary COVID-19 Vaccination Series — 465 Health Care Facilities, United States, December 2020–October 2021. MMWR Morb Mortal Wkly Rep 2022;71:19–25. DOI: https://www.cdc.gov/mmwr/volumes/71/wr/mm7101a4.htm?s_cid=mm7101a4_w

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.