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Breakthrough COVID infections more likely in people living with HIV

By Alan Mozes
health day reporter

WEDNESDAY, June 8, 2022 (HealthDay News) — Even after vaccination, living with HIV increases chances of COVID infection, new research suggests.

The study found that vaccinated people living with HIV have a 28% higher risk of developing a “breakthrough” COVID infection compared to those who do not have the virus that causes AIDS.

That’s the bad news. But there is also good news: the overall risk of COVID infection in people vaccinated with at least the two primary doses remains low, regardless of their HIV status.

“We thought we might see an increased risk of breakthrough in people with HIV due to the impact of HIV on immune system and the role of the immune system in the response to vaccination and infection with a virus like SARS-Cov-2,” explained study author Keri Althoff.

So the researchers weren’t surprised to find “that about 4 out of 100 people living with HIV experience a breakthrough, compared to 3 out of 100 people without HIV,” said Althoff, an associate professor in the department of epidemiology at the Johns Hopkins School of Public Health.

But it was a relief, she says, to see that nine months after vaccination, “the rate and risk of breakthrough is low in people vaccinated with and without HIV” – around 4% in each group.

His team analyzed data from nearly 114,000 men and women vaccinated against COVID, 33,000 of whom had HIV. Most were 55 or older, 70% were Caucasian, and more than 9 in 10 were male.

The authors focused on the risk of COVID during the second half of 2021, when the most contagious Omicron variant emerged. Althoff noted that breakthrough infections were higher across all domains — regardless of HIV status — in December, when Omicron became the dominant strain.

Beyond identifying the 28% higher risk of breakthrough infection in people living with HIV, the researchers noted that some people living with HIV face a higher risk of infection than others. others. They included people under the age of 45, compared to those between 45 and 54. The risk was also higher in those who had not received a third dose (or booster) and those who had already been infected.

The risk of breakthrough infection in people living with HIV also increased as their T-cell counts decreased. According to the US National Library of Medicine, T cells are essential infection-fighting white blood cells that are commonly attacked by HIV. (When an HIV patient’s T-cell count drops to an extremely low level, it’s often a sign of transition to full-blown AIDS.)

Althoff said she and her colleagues “have hypothesized that HIV-induced immune dysfunction may play a role in vulnerability to COVID breakthrough-19 disease.”

For this reason, reminders can be essential for these patients, she said.

Currently, Althoff pointed out, third-dose boosters are recommended for those with untreated or advanced HIV.

“To increase protection against breakthrough infections, all people with HIV may need an additional dose in their primary series,” she noted.

This thought was echoed by Dr. Joel Blankson, a professor of medicine at Johns Hopkins Medicine, who was not part of the study.

Because the study showed a decrease in breakthrough infections in patients who had received a third dose of vaccine, “it is important that people living with HIV receive a booster dose when they are eligible,” said said Blankson. The United States Centers for Disease Control and Prevention has COVID vaccine guidelines here.

Additional research by Althoff’s team suggests that the risk of hospitalization for new cases is higher in people with HIV than in those who are not. (These results are still under peer review and not yet published.)

His advice to people living with HIV: “Get vaccinated. Get boosted. Continue to live your life and scale up and down your mitigation strategies — wearing a mask, attending indoor gatherings, etc. – – depending on the amount of transmission of COVID-19 in your community and your personal health status.

Dr. Thomas Gut is Associate Director of Medicine at the Zucker School of Medicine at Hofstra/Northwell in New York.

“The HIV-related risk of reinfection is somewhat expected,” said Gut, who had no role in the study. “In many other infectious diseases besides COVID, HIV patients are known to tend to have a higher risk of getting sick and having poorer outcomes.”

But HIV-positive patients “who have high immune cell counts are traditionally known to be better protected against infection than those with weak immune systems,” he added. “It appears that the risk of COVID reinfection follows the same pattern.”

Therefore, Gut said, it is important to control HIV infection as well as possible.

The results are in the June 7 issue of JAMA network open.

More information

There is more about HIV and COVID-19 status on HIV.gov.

SOURCES: Keri N. Althoff, PhD, MPH, associate professor, epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore; Joel N. Blankson, MD, PhD, professor of medicine, Johns Hopkins Medicine, Baltimore; Thomas Gut, DO, associate chair, medicine, and director, ambulatory care services, Zucker School of Medicine at Hofstra/Northwell, Staten Island, NY; Open JAMA Network, June 7, 2022

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