Should people living with HIV get vaccines early in the roll out?

WHO recommends that countries refer to the WHO SAGE Roadmap For Prioritizing Uses Of COVID-19 Vaccines In The Context Of Limited Supply[7] which was created under the assumption  that there would not be substantive differences in vaccine efficacy among subgroups (for example, in people with comorbidities that increase the risk of severe COVID-19 such as HIV-positive status). Therefore countries can make plans for people to receive the vaccine in order of priority based on their age, health, occupation and other factors such as people in living in care or residential homes, or closed settings such as prisons. Some countries are prioritizing vaccination for all people living with HIV or for those who are immunocompromised (as indicated by having a CD4 cell count <200/mm3) [8],[9].

An informal poll of 52 countries revealed 24 that have an immunization policy that prioritizes vaccinations for people living with HIV. These policies are supported by recent literature which suggests that people living with HIV at any CD4 count appear to be at increased risk for severe outcomes and death due to COVID-19 compared with people without HIV[10],[11],[12]. Independent of the immune status, many people living with HIV have one or more comorbidities that may put them at increased risk for a more severe COVID-19. Therefore, people living with HIV with co-morbidities (such as COPD, asthma, diabetes, heart disease, kidney disease, liver disease, Parkinson’s disease, multiple sclerosis, motor neurone disease, severe obesity) should be prioritized for early vaccination in most settings. People living with HIV should not be excluded from COVID-19 vaccine access plans regardless of their immune status, and countries ought to consider including people living with HIV as a priority group for COVID-19 vaccination according to their epidemiological context.