COVID booster vaccinations – HIV update, 10 May 2022

COVID booster vaccinations

The British HIV Association (BHIVA) and the UK's Joint Committee on Vaccination and Immunisation (JCVI) are recommending that people aged 12 years and over who are immunosuppressed (including all people with HIV) should have a spring booster dose six months after their last vaccine dose – even if they have already had a previous booster.

This booster should be of one of the two mRNA vaccines made by Pfizer or Moderna, even for people who originally had the Oxford/AstraZeneca vaccine. 

Given that three doses were recommended as the original vaccine regimen for people with HIV and other clinically vulnerable people, and that some people with HIV have already had a booster dose this winter, the spring booster could be people’s third, fourth or even fifth COVID vaccine shot.

BHIVA strongly encourages all people living with HIV to have the recommended COVID vaccines. This is because responses to first and second vaccine doses can be lower in some people with HIV, particularly those with a CD4 count below 350 cells or with detectable HIV viral load. Additional vaccine doses are especially important for this group.

What happened to HIV care during COVID-19?

The COVID pandemic has had a huge impact on all our lives. Some health services fear that they have lost touch with some patients and that they may not have spotted new health issues in other people, even if they did continue to have some forms of contact.

The impact of the pandemic on health care is likely to vary in different places and in different people, depending in part on how well managed the situation was. It’s feared that more vulnerable patients are more likely to have missed out on care they needed.

One of the most comprehensive assessments of this in HIV has come from the largest HIV care centre in Spain, located in Barcelona. The researchers compared monthly data from the year before COVID-19 (March to December 2019) to during the first year of the pandemic (March to December 2020), which included two lockdowns.

Most results for people with ongoing HIV care were reassuring, though some changes could mean that some aspects of care were missed or weren’t considered a priority.

• 25% fewer appointments for people living with HIV, even with almost 40% of them conducted via telephone, email or video.
• No change in the number of viral load tests.
• No change in the number of people with detectable viral loads.
• 12% fewer hospital admissions.
• 10% fewer blood tests for cholesterol and glucose.
• 10% fewer switches of HIV treatment regimens.

There are more concerns about HIV testing. There were 28% fewer HIV diagnoses, and newly diagnosed cases were more advanced. The average CD4 count at diagnosis fell (from 370 to 305) and the proportion of people diagnosed with an AIDS-defining condition increased (from 10% to 18%). This is probably because people’s diagnoses were delayed by problems accessing health care.

And death rates went up. In the period before COVID-19, there were eleven deaths, increasing to 29 during the first year of the pandemic. Eleven of the 29 deaths were directly due to COVID-19.

Weight gain

As for anyone, it’s important for people with HIV to maintain a healthy body weight. Maintaining a healthy weight is about balancing the energy you take in and use up. If you consume more energy (calories) than you use, you’re likely to gain weight. On the other hand, if you burn more calories than you eat, the chances are you’ll lose weight.

After starting HIV treatment, you may gain some weight as your health improves. Some people gain quite a lot of weight after starting or changing treatment. This weight gain may increase your risk of diabetes, heart disease or cancer.

The issue of weight gain has been highlighted by a recent study conducted with just under 400 women living with HIV in the UK. They were all aged 45 to 60 and were mostly doing well on treatment.

Around four in ten of the women had a body mass index (BMI) greater than or equal to 30 – which is considered obese. Less than a third of the women had a normal weight (BMI below 25) and a third were considered overweight (BMI between 25 and 30).

Average weight varied according to ethnicity. Half of Black African women had a BMI over 29, whereas half of White British women had a BMI over 24.

BMI is calculated using  your weight and height. It is easy to measure and is widely used by doctors. However, it doesn’t take into account where in the body fat is stored (fat around the waist poses more health problems than fat elsewhere), or consider whether additional kilos are made up of muscle or fat.

The UK’s National Institute for Health and Care Excellence (NICE) recently updated its guidelines to recommend that even adults with a ‘normal’ BMI should keep their waist measurement to half their height.

Adherence and depression

Depression is an ongoing low mood which interferes with your everyday life. It is a very common health problem for people living with HIV – and is linked to lower rates of adherence to HIV treatment.

For example, a recent study from Taiwan found that men living with HIV who had depression were more likely to miss some doses of their medication (22%) than men who weren’t depressed (11%). But when the researchers looked at the results more closely, they found that what really made a difference was whether people with depression were taking antidepressant medications.

Those who were on antidepressants were not more likely to have poor adherence than other men with HIV. But those who had depression which wasn’t being treated were four times more likely to miss doses than other men.

The study also showed that those not taking antidepressants rated their quality of life as poorer than those who were taking antidepressants.

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