Guidance for People Living with HIV from the British HIV Association (BHIVA), National AIDS Trust (NAT) and the Terrence Higgins Trust (THT)
Friday 17 December 2021
BHIVA strongly recommends COVID vaccines for all people with HIV. If you are worried about whether vaccines are safe or effective you can get more information here: https://www.england.nhs.uk/london/our-work/covid-19-vaccination-programme-2/covid-19-vaccine-communication-materials/
Updated advice on COVID vaccines
The Joint Committee on Vaccination and Immunisation (JCVI) has updated its advice on COVID vaccination:
A booster vaccine should be offered to everyone aged 18 years or older from 3 months after their second vaccine, or after the third dose if you were advised to have one.
The JCVI continues to recommend that a third dose is offered to those with severe immunosuppression (a weaker immune system) from eight weeks after their second vaccination. You will also need a booster from 3 months’ after the third dose.
What’s the difference between a third dose and a booster?
Third dose
This third dose is for people who have a weaker immune system so that two doses are not enough to provide protection. There is some evidence that a third dose will improve vaccine response. The third dose is part of the “primary,” or first, course of vaccinations, and should be given at least 8 weeks after the second dose.
People whose immune system is weaker because of medical conditions or treatments, and who therefore need a third dose, are listed in Reference 1. This guidance applies to all people age 12 or older. If your immune system is weaker then you may already have been given a third dose, after being contacted by your GP or HIV clinic.
Booster
Everybody’s response to vaccines gets weaker over time, even people with healthy immune systems. The effectiveness of the COVID vaccine is expected to drop after 6 months but the increase in cases of the Omicron variant means that most people are now being offered boosters sooner.
Everyone living with HIV should have a booster from 3 months after the second vaccination or, after the third vaccination, if they received one.
Some people with HIV on effective HIV treatment with a high CD4 count had a third dose although their immune system was not actually weaker. If this describes you, then that third dose can count as a booster. You will not need another booster at the moment. However, if you do get four vaccine doses instead of three, don’t worry, as it will not be a problem.
Do all people with HIV need a third dose of COVID vaccine?
No. Evidence to date shows that people with HIV who are undetectable on treatment respond as well to vaccination as people who do not have HIV. Most people in the studies showing this had high CD4 counts (above 350). However, there is some evidence that people with a low CD4 count respond less strongly to vaccination, which is why they were offered a third dose.
The JCVI recommends everyone living with HIV aged 12 years or older with a CD4 count less than 200 should have a third dose 8 weeks after their second vaccination, or as soon as possible after that. BHIVA supports this recommendation and also advises a third dose for the following people:
1) People who had a serious HIV-related illness in the 12 months before their first COVID vaccine dose (eg AIDS-defining illness, tuberculosis).
2) People not taking recommended HIV treatment.
3) Some people who have a detectable viral load despite treatment. Their clinic will consider other things like CD4 count and then talk to them on a one-to-one basis about whether an immediate third dose is needed.
Some people with HIV have been offered or received a third dose when they do not actually need one. This may be because GPs do not have up to date information on everyone’s CD4 count or because they are erring on the side of caution. This means they have effectively already had their booster (see above).
If you were advised to have a third dose but haven’t, we strongly advise that you get one as soon as possible. If you think you should have had a third dose you can talk to your HIV clinic or GP or book one online.
What is the recommended gap between doses?
The third dose should be given at least 8 weeks after the second dose. If you have a low CD4 count, and have just started HIV treatment, your clinic may advise you to wait a few weeks for your third dose.
A booster should be given at least 3 months after the second or third dose.
What type of vaccine will the third dose be?
For third doses, JCVI recommends an mRNA vaccine, such as Pfizer or Moderna. In some situations the third dose can be with an Astra Zeneca vaccine.
For boosters, JCVI recommends an mRNA vaccine. In rare situations Astra Zeneca can be used.
Immunity testing
Blood tests have been used in research trials to measure how strongly someone has responded to the COVID vaccine. However, it is not currently recommended that blood tests are done to decide if a third vaccine is needed.
References
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