COVID-19 Vaccine for persons living with HIV
Introduction
The UK was the first country to approve the use of a COVID-19 vaccine, which is being referred to as ‘The Pfizer vaccine,’ and vaccination with this started on the 8th December 2020. There is also another vaccine, known as ‘the AstraZeneca vaccine’ or ‘the Oxford vaccine,’ which has also been shown to be very effective at preventing COVID-19 and vaccination with this started on 4th January 2021. Other vaccines are also in the pipeline, including the Moderna vaccine, which was approved for use in the UK on 8th January 2021, with first vaccinations expected in the Spring.
The patient information leaflets for the three currently approved COVID-19 vaccines (Pfizer/BioNTech, AstraZeneca/Oxford and Moderna) all list a weakened immune system under the warnings and precautions for use, with Pfizer using HIV as an example. The leaflets advise affected patients to tell their doctor, nurse or pharmacist before vaccination. The British HIV Association has contacted Pfizer to challenge the mention of HIV in the leaflet.
This advice in the patient information leaflets is not based on concerns about safety. There is currently no evidence for more side effects in people with HIV. The guidance is there mainly because there is not yet very much research information about people with immune deficiency and/or HIV.
With some vaccines, people with HIV can produce a weaker response. We do not yet know if this is the case for the COVID-19 vaccines but they are expected to be protective in people with HIV and are recommended.
Are the vaccines live?
None of the COVID-19 vaccines contain any live virus and so cannot cause COVID-19. The AstraZeneca/Oxford vaccine contains a cold virus, called adenovirus, which has been changed to make it inactive; similar adenovirus vaccines have been used and studied in populations where HIV is common and have been shown to be safe. All currently approved vaccines are thought to be safe for people with suppressed immune systems.
Is there any interplay between COVID-19 vaccine and HIV drugs?
No. HIV drugs do not affect the effectiveness of COVID-19 vaccines and COVID-19 vaccines do not affect how well HIV drugs work either. If you have had side effects or an allergic reaction to particular HIV drugs in the past, that does not mean you will get side effects from the COVID-19 vaccines.
There is no evidence that HIV drugs, taken as HIV treatment or prevention (PrEP) can be used to prevent or treat COVID-19. Some studies are looking into using HIV drugs to prevent COVID-19 but there are no results yet and no good evidence to suggest they will be effective.
Who will be prioritised to get the vaccine early?
People will receive the vaccine in strict order of priority based on their age, health, occupation, whether they live in a care or residential home and who they live with. Vaccines will be offered strictly based on these priorities. There is no way to jump the queue, and you will be contacted when your vaccine is due.
There are 9 priority groups: those in priority group 1 will get the vaccine first, followed by each in turn up until priority 9. After that the vaccine will be offered to everyone else (that is all the people not in priority groups 1-9).
Will persons living with HIV be prioritised for the vaccine?
Everyone living with HIV fall into the Priority group 6: people with underlying health conditions which put them at higher risk of serious disease and mortality.
A small proportion of people living with HIV will fall into Priority group 4 (Clinically Extremely Vulnerable).
This includes individuals with a CD4 count less than 50 cells/mm3, or who have had an opportunistic illness in the last 6 months. Individuals with a CD4 count in the range 50-200 cells/mm3, with additional risk factors may also be added to this category following assessment by their clinician.
In West Sussex we have reviewed all patients accessing care through our service and have identified and contacted ALL individuals who fall into priority group 4. If you have not been contacted by the Consultant responsible for your care, you do not fall into this category in relation to your HIV status (you may of course have been contacted by your GP and placed in this category for non-HIV related reasons).
If you have not already received a COVID vaccination for other reasons, you will be eligible for vaccination in priority group 6. The national vaccination programme will shortly be moving onto this group and therefore you will receive a text message from the West Sussex HIV service in the next couple of weeks, confirming your eligibility for priority vaccination and advice to contact your GP.
Who do I contact if I have questions?
There are a lot of false rumours circulating about the COVID vaccines which has created concern and low vaccine uptake, particularly in some with higher risk of severe disease or death from COVID infection.
The British HIV Association (BHIVA) www.bhiva.org has lots of information about COVID, vaccination and HIV.
If after reading the information available you have questions about the safety or effectiveness of the vaccine, please contact your local clinic to discuss your concerns with your Doctor.
If you want to receive the vaccine please contact your GP for advice on local vaccination centres. We are unable to offer you the vaccine in your HIV clinic. You can use the text received from our service as evidence for your eligibility in priority group 6.