Journal
JAMA NETWORK OPEN
Volume 5, Issue 10, Pages -Publisher
AMER MEDICAL ASSOC
DOI: 10.1001/jamanetworkopen.2022.36397
Keywords
-
Categories
Funding
- National Institute of Allergy and Infectious Diseases (NIAID) [U01AI069918]
- NIH [U01AI069918, F31AI124794, F31DA037788, G12MD007583, K01AI093197, K01AI131895, K23EY013707, K24AI065298, K24AI118591, K24DA000432, KL2TR000421, N01CP01004, N02CP055504, N02CP91027, P30AI027757, P30AI027763, P30AI027767]
- THE NIH [P30AI036219, P30AI050409, P30AI050410, P30AI094189, P30AI110527, P30MH62246, R01AA016893, R01DA011602, R01DA012568, R01AG053100, R24AI067039, R34DA045592, U01AA013566, U01AA020790, U01AI038855, U01AI038858, U01AI068634, U01AI068636, U01AI069432, U01AI069434, U01DA036297]
- Centers for Disease Control and Prevention (CDC) [CDC-200-2006-18797, CDC-200-2015-63931]
- Agency for Healthcare Research and Quality [90047713]
- Health Resources and Services Administration [90051652]
- Grady Health System
- CIHR [CBR-86906, CBR-94036, HCP-97105, TGF-96118]
- Ontario Ministry of Health and Long Term Care
- Government of Alberta, Canada
- NIAID
- National Cancer Institute
- National Heart, Lung, and Blood Institute
- Eunice Kennedy Shriver National Institute of Child Health & Human Development
- National Human Genome Research Institute
- National Institute for Mental Health
- National Institute on Drug Abuse
- National Institute on Aging
- National Institute of Dental & Craniofacial Research
- National Institute of Neurological Disorders and Stroke
- National Institute of Nursing Research
- National Institute on Alcohol Abuse and Alcoholism
- National Institute on Deafness and Other Communication Disorders
- National Institute of Diabetes and Digestive and Kidney Diseases
- [U01DA036935]
- [U10EY008057]
- [U10EY008052]
- [U10EY008067]
- [U01HL146192]
- [U01HL146193]
- [U01HL146194]
- [U01HL146201]
- [U01HL146202]
- [U01HL146203]
- [U01HL146204]
- [U01HL146205]
- [U01HL146208]
- [U01HL146240]
- [U01HL146241]
- [U01HL146242]
- [U01HL146245]
- [U01HL146333]
- [U24AA020794]
- [U54GM133807]
- [UL1RR024131]
- [UL1TR000004]
- [UL1TR000083]
- [UL1TR002378]
- [UL1TR002489]
- [Z01CP010214]
- [Z01CP010176]
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This cohort study found that the risk of severe breakthrough COVID-19 within 28 days of vaccination was low among both vaccinated people with HIV and those without HIV. However, individuals with moderate or severe immune suppression had a higher risk of severe breakthrough infection and should be prioritized for additional vaccine doses and risk-reduction strategies.
IMPORTANCE Understanding the severity of postvaccination SARS-CoV-2 (ie, COVID-19) breakthrough illness among people with HIV (PWH) can inform vaccine guidelines and risk-reduction recommendations. OBJECTIVE To estimate the rate and risk of severe breakthrough illness among vaccinated PWH and people without HIV (PWoH) who experience a breakthrough infection. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, the Corona-Infectious-Virus Epidemiology Team (CIVET-II) collaboration included adults (aged >= 18 years) with HIV who were receiving care and were fully vaccinated by June 30, 2021, along with PWoH matched according to date fully vaccinated, age group, race, ethnicity, and sex from 4 US integrated health systems and academic centers. Those with postvaccination COVID-19 breakthrough before December 31, 2021, were eligible. EXPOSURES HIV infection. MAIN OUTCOMES AND MEASURES The main outcome was severe COVID-19 breakthrough illness, defined as hospitalization within 28 days after a breakthrough SARS-CoV-2 infection with a primary or secondary COVID-19 discharge diagnosis. Discrete time proportional hazards models estimated adjusted hazard ratios (aHRs) and 95% CIs of severe breakthrough illness within 28 days of breakthrough COVID-19 by HIV status adjusting for demographic variables, COVID-19 vaccine type, and clinical factors. The proportion of patients who received mechanical ventilation or died was compared by HIV status. RESULTS Among 3649 patients with breakthrough COVID-19 (1241 PWH and 2408 PWoH), most were aged 55 years or older (2182 patients [59.8%]) and male (3244 patients [88.9%]). The cumulative incidence of severe illness in the first 28 days was low and comparable between PWoH and PWH (7.3% vs 6.7%; risk difference, -0.67%; 95% CI, -2.58% to 1.23%). The risk of severe breakthrough illness was 59% higher in PWH with CD4 cell counts less than 350 cells/mu L compared with PWoH (aHR, 1.59; 95% CI, 0.99 to 2.46; P=.049). In multivariable analyses among PWH, being female, older, having a cancer diagnosis, and lower CD4 cell count were associated with increased risk of severe breakthrough illness, whereas previous COVID-19 was associated with reduced risk. Among 249 hospitalized patients, 24 (9.6%) were mechanically ventilated and 20 (8.0%) died, with no difference by HIV status. CONCLUSIONS AND RELEVANCE In this cohort study, the risk of severe COVID-19 breakthrough illness within 28 days of a breakthrough infection was low among vaccinated PWH and PWoH. PWH with moderate or severe immune suppression had a higher risk of severe breakthrough infection and should be included in groups prioritized for additional vaccine doses and risk-reduction strategies.
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