BHIVA guidelines on COVID-19 vaccines and people living with HIV: DRAFT online for comment

Simon Collins, HIV i-Base

On 24 March 2021, the British HIV Association (BHIVA) posted draft guidelines on COVID-19 vaccinations in people living with HIV. The guidelines are online for comment for a month until 24 April 2021. [1]

A plain-language community summary will be posted online in the next week or so, at the same link. [1]

The 17-page document reviews current evidence on the efficacy and safety of the main vaccines. It includes the following key recommendations.

• The increased risk of severe COVID-19 associated with HIV means that routine COVID-19 vaccination is strongly recommended for ALL people living with HIV.
• There are no HIV-specific safety concerns for any of the mRNA, adenovirus or vector (protein) based vaccines. There are no concerns related to CD4 count or viral load.
• The few contraindications (serious allergy to ingredients) are the same for people who are HIV positive and HIV negative.
• The first vaccine offered is recommended: no vaccine is better than another.
• Vaccinations are especially important for anyone with higher risks for COVID-19. These include:
  • HIV factors (low CD4 or detectable viral load).
  • Non-HIV factors (other serious health issues).
  • Pregnancy.
• It is important to complete the course (having both vaccine shots). The second vaccination should routinely be the same make, unless there was a severe reaction to the first shot. It the same vaccine is not available for any reason, a different vaccine can be used.
• There is limited data on the duration of protection. Even if this if affected HIV a high degree of cover is still expected from all vaccines.
• Further research will decide on whether future vaccine boosts are recommended. This includes in people living with HIV.
• Vaccine protection should not be assumed. Future symptoms should still involve SARS-CoV-2 testing and speaking to a doctor.
• Evaluating individual immune responses with antibody tests, either before or after vaccination, is not recommended, unless part of a research study.
• Vaccines are recommended even if you recently had coronavirus. If symptoms are very recent, it is best to wait about four weeks before having the vaccine.
• No recommendations are made for use of passive immunisation other that in a research setting.
• As with HIV negative people, taking part in research studies is supported and recommended when appropriate.

Reference

1. British HIV Association guidelines on immunisation for adults with HIV: SARS-CoV-2 (COVID-19) 2021 – consultation open. (24 March 2021).
   https://www.bhiva.org/COVID-19-immunisation-guidelines-consultation (webpage)
   https://www.bhiva.org/file/605b1447c8ffa/COVID-19-Immunisation-Guidelines-Consultation.pdf (PDF link)