BHIVA statements on third vaccine doses for people living with HIV

Simon Collins, HIV i-Base

On 3 September 2021, the British HIV Association (BHIVA) published an online statement on the use of third primary doses of vaccinations against COVID-19 by people living with HIV. This also helpfully included a community summary. [1, 2]

These explain the latest recommendations from the UK Joint Committee on Vaccination and Immunisation (JCVI) where immunosuppression, including HIV, is included as one of the criteria for having a third dose. Importantly, although the JCVI documents define a CD4 threshold less than 200 cells/mm3  they also allow for flexibility that lets doctors make this decision on an individual patent level. Access to the third dose requires the HIV specialist to provide clear advice when notifying the GP. [3]

The documents from BHIVA stress that most people living with HIV do not current need a third dose. They emphaise that vaccine responses at high CD4 counts (above 350 cells/mm³) will be similar to the general population. The CD4 threshold is a conservation suggestion given the lack of data at lower CD4 counts.

Additional criteria for a third dose includes HIV-related symptoms (at any CD4 count), persistent detectable viral load (after > 1 year on ART) and people not yet on ART.

Both the BHIVA documents were updated two weeks later. [4, 5]

Please see these latest updates for full details.

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These third doses are to supplement potential suboptimal responses to standard COVID-19 vaccine schedules. They are to equalise protection expected in the general population.

This is separate to discussions about the need for booster doses, to support waning immune responses approximately 6-8 months after a full vaccine schedule.

They are different again to the use of redesigned booster vaccines that might in the future be developed specifically to overcome current and future variants.

All documents also recognise that these guidelines and discussions are based on limited evidence.

References

1. BHIVA. BHIVA statement on JCVI recommendations for a third COVID-19 vaccine dose. (3 September 2021).
   https://www.bhiva.org/BHIVA-statement-on-JCVI-recommendations-for-a-third-COVID-19-vaccine-dose
2. Guidance for People Living with HIV from the British HIV Association (BHIVA), National AIDS Trust (NAT) and the Terrence Higgins Trust (THT). (3 September 2021).
   https://www.bhiva.org/recommendations-from-the-JCVI-on-a-third-COVID-vaccine-dose
3. JCVI. Report from the Joint Committee on Vaccination and Immunisation (JCVI) advice on third primary dose vaccination. (1 September 2021).
   https://www.gov.uk/government/publications/third-primary-covid-19-vaccine-dose-for-people-who-are-immunosuppressed-jcvi-advice/joint-committee-on-vaccination-and-immunisation-jcvi-advice-on-third-primary-dose-vaccination
4. BHIVA. BHIVA statement on JCVI recommendations for a third COVID-19 vaccine dose. (16 September 2021).
   https://www.bhiva.org/updated-BHIVA-statement-on-JCVI-recommendations-for-a-third-COVID-19-vaccine-dose
5. Guidance for People Living with HIV from the British HIV Association (BHIVA), National AIDS Trust (NAT) and the Terrence Higgins Trust (THT). (16 September 2021).
   https://www.bhiva.org/updated-recommendations-from-the-JCVI-on-a-third-COVID-vaccine-dose