People with HIV

While WHO is working with countries to ensure fair and equitable access to safe and effective COVID-19 vaccines, it is important to continue actions to prevent SARS-CoV-2 transmission and to reduce COVID-19 deaths. Alongside the response to COVID-19, it is critical to maintain access to essential health services. This includes:
  • Supporting people living with HIV to continue taking antiretroviral therapy (ART) and adapting services to make this easier and more efficient during the COVID-19 response.
  • Continuing to provide HIV prevention and testing services with linkage to ART initiation as a priority.
  • Ensuring those who start ART can remain on it to reduce health risks and complications during COVID-19. This must be classified as an essential service, together with prevention, diagnosis and treatment of co-morbidities and co-infections.
  • Monitoring all people living with HIV and SARS-CoV-2 infections, especially those with advanced HIV disease or with co-morbidities.
Although there may be an increase in the risk of developing severe disease from COVID-19 among people living with HIV, making sure that people have access to effective ART and other health care they need will help to minimize this risk. For further information on COVID-19 vaccines and all WHO guidance related to COVID-19 see
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.
It is theoretically possible that people living with HIV with low CD4 cell counts might have a weaker immune response to vaccines. However, in practice this has not been documented for all vaccines and there is no evidence to support a less robust immune response to COVID-19 vaccines among people living with HIV and low CD4 cell counts. WHO is reviewing new evidence as it emerges and will provide updates.  More importantly, advocacy is needed so that no one person is left behind and that national COVID-19 vaccination programmes do not exclude people from key and vulnerable populations, at risk of HIV, who may have limited access to health services. It is also important to advocate for the inclusion of people living with HIV, including those with more advanced disease, in COVID-19 vaccine trials to provide information to confirm efficacy.
Many of the COVID-19 vaccines studies have included a small number of people living with HIV in their trials. Despite limited data, available information suggests current WHO recommended COVID-19 vaccines (Pfizer/BioNtech, Oxford/AstraZeneca, Johnson&Johnson) are safe for people living with HIV. The currently available vaccine products are not live vaccines, they include genetic material from SARS-CoV-2 which cannot replicate. Therefore these vaccines are not expected to be less safe in people who are immunocompromised. In addition to this, no pharmacological interactions have been reported between COVID-19 vaccines and antiretroviral medications which people living with HIV should continue to take after vaccination to maintain health. Recently, a debate in the scientific literature has led to broader concerns about a potential association observed more than a decade ago between adenovirus vector-based vaccines and an increased risk of acquiring HIV infection among men who received this type of vaccine[1]. This unexpected finding was detected in two HIV vaccine trials that used adenovirus vector containing products[2],[3]. The reason for this observed HIV risk remains uncertain, although several follow-up studies have suggested a possible interference in the HIV specific vaccine response or in the CD4 cell susceptibility to HIV infection induced by this kind of vaccine[4],[5]. However, a third study using another adenovirus vector-based vaccine, conducted more recently has not reported this finding[6]. Specific studies on this topic with COVID-19 vaccines are needed. Despite these potential concerns, it is important to highlight that the benefits of all authorized COVID-19 vaccines in a pandemic context currently outweigh the potential risks. WHO will continue to monitor the situation as new data become available and SAGE recommendations will be updated accordingly.