By Mary Hearty

With evidence showing that people living with HIV have an increased risk for severe disease from COVID-19 as well as hospitalization and death, expert calls for prioritizing them in COVID-19 vaccination.

During World Health Organization (WHO)  ‘Science in 5’ interview on HIV and COVID-19, Dr Meg Doherty, Director of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes at WHO noted that the current vaccines are safe for people living with HIV and certainly provides adequate protection.

“We urgently need to start vaccinating people around the world and put people living with HIV right up there in the line of people who need vaccines, along with people with co-morbidities, who are older, who are front line workers,” Dr. Doherty said.

Also, she said studies are still on-going on whether people who have low immunity need to have another dose of vaccine.

“We will be looking forward to knowing whether people living with HIV might need a booster shot in the future. But what we know right now is most of the world, in the low and middle income countries like Africa which has the highest burden of HIV; they still need the first vaccines the most,” Dr Doherty emphasized.

According to Dr Katherine O’Brien, Executive Director of the International Vaccine Access Centre and Professor of International Health and Epidemiology at John Hopkins Bloomberg School of Public Health there are three reasons why people might be given an additional dose.

The first is if one did not respond to the first two doses, like immuno-compromised people, then it may be necessary to receive a third dose unlike normal, healthy people.

Also, Dr O’Brien said: “If over time the immunity that you received and achieved as a result of being vaccinated starts to wane, it starts to deteriorate or go down over time.”

The third scenario is if the performances of the vaccines are less or inadequate against some of the variants of concern that have emerged, adding that the available vaccines are holding up extremely well against the severe end of the disease spectrum. So we do not see strong evidence leading to a need to provide a third dose for people who have already been vaccinated, she said.

Moreover, she affirmed that before giving people with low immunity the third dose, safety issues must be considered. “We would like to see a safety database before we would make any such recommendation. And that evidence is also building, but we’re not there yet.”

Dr Doherty said that despite concerns that the newer generation vaccines may not be as effective among people living with HIV who have very low CD4 counts, people who are not on treatment or have immunosuppression; there is no clear data yet to support these fears.

“We have to follow this forward as we learn more about some of the clinical trials that are happening in South Africa for some of these newer generation vaccines. And we would be very encouraging of people living with HIV to access those vaccines and not to have any differentiation in terms of whether or not they have a low CD4, high CD4 or suppress viral load or not,” Dr Doherty explained.