COVID-19 vaccines protect people with HIV from severe illness and death

Two major studies from the USA and Denmark show that people with HIV who get vaccinated against COVID-19 are unlikely to get seriously ill or die from coronavirus. But people with low CD4 counts are more at risk. 

What is the research about? 

COVID-19 outcomes among people with HIV, and the effects of COVID-19 vaccines.  

In the USA, researchers compared cases of COVID-19 among 33,000 people with HIV and 81,000 people without HIV (matched on age, sex, race and ethnicity). All participants had been vaccinated.  

In Denmark, researchers compared data from all adults with HIV (5,280) with an age-and sex matched group of people without HIV (42,300). They assessed the difference in COVID-19 infections and outcomes, plus the effect of vaccinations. 

Why is this research important? 

There is a lack of evidence on COVID-19 outcomes among people with HIV and how well vaccines work. It is particularly important to understand whether being virally suppressed protects people with HIV from getting ill or dying from COVID-19. 

What did they find out? 

USA study  

In both groups (people with HIV and people without HIV) around 7% of people became severely ill due to COVID-19 after getting vaccinated. (Being severely ill was defined as needing to go to hospital.) This means the risk of hospitalisation was the same for people with and without HIV. In both groups, being older was the biggest reason people became severely ill due to COVID-19.  

Among those who were hospitalised, around 10% were ill enough to need mechanical ventilation and 1% died. Again, there was no difference between people with and without HIV on these measures. 

Immune system health was a factor in how severely ill people with HIV became if they got COVID-19 after being vaccinated. Vaccinated people with HIV who had a CD4 cell count less than 350 were 59% more likely to be hospitalised due to COVID-19 than vaccinated people without HIV. But there was no difference in this risk between vaccinated people with HIV with CD4 counts above 350 and vaccinated people without HIV. 

The risk of getting severe COVID-19 increased with a decreasing CD4 cell count. Vaccinated people with HIV who had CD4 counts between 200 and 349 were 65% more likely to get severe COVID-19 than vaccinated people with HIV who had CD4 counts above 500. More vaccinated people with HIV who had CD4 cell counts less than 350 needed mechanical ventilation or died than vaccinated people with HIV who had higher CD4 counts. 

Danish study  

People with HIV had almost the same risk of getting COVID-19 as people without HIV. 

But people with HIV were around twice as likely to be hospitalised due to COVID-19 than people without HIV. However, hospitalisation rates for people with HIV fell after the vaccine became available. In 2020, the risk of hospitalisation due to COVID-19 for people with HIV was 70% higher than in 2022. 

Among those hospitalised for COVID-19, people with HIV were twice as likely to need mechanical ventilation than people without HIV. But the risk of dying from COVID-19 was about the same for people with and without HIV. 

People with HIV who had a booster vaccine were 10% less likely to get COVID-19 than people with HIV who did not get a booster. Among people with HIV aged 60 or over, the risk of dying from COVID-19 reduced by 80% after getting a booster.  

What does this mean for HIV services? 

It is important to encourage people with HIV to get the COVID-19 vaccination. There is a need to reassure people with HIV that COVID-19 vaccines are safe and effective, and that getting vaccinated is something they can do to protect their health.  

COVID-19 vaccinations are especially important for people with HIV who are older or are not virally suppressed, as they are more at risk of becoming severely ill or dying from COVID-19. In countries where booster doses are available, older people with HIV and people with low CD4 counts should be prioritised.