{"doi":"10.1101/2021.12.02.21267182","title":"COVID-19 infections post-vaccination by HIV status in the United States","abstract":"IMPORTANCE: Recommendations for additional doses of COVID vaccine are restricted to people with HIV who have advanced disease or unsuppressed HIV viral load. Understanding SARS-CoV-2 infection risk post-vaccination among PWH is essential for informing vaccination guidelines. OBJECTIVE: Estimate the risk of breakthrough infections among fully vaccinated people with (PWH) and without (PWoH) HIV in the US. DESIGN SETTING AND PARTICIPANTS: The Corona-Infectious-Virus Epidemiology Team (CIVET)-II cohort collaboration consists of 4 longitudinal cohorts from integrated health systems and academic health centers. Each cohort identified individuals ≥18 years old, in-care, and fully vaccinated for COVID-19 through 30 June 2021. PWH were matched to PWoH on date fully vaccinated, age group, race/ethnicity, and sex at birth. Incidence rates per 1,000 person-years and cumulative incidence of breakthrough infections with 95% confidence intervals ([,]) were estimated by HIV status. Cox proportional hazards models estimated adjusted hazard ratios (aHR) of breakthrough infections by HIV status adjusting for demographic factors, prior COVID-19 illness, vaccine type (BNT162b2, [Pfizer], mRNA-1273 [Moderna], Jansen Ad26.COV2.S [J&J]), calendar time, and cohort. Risk factors for breakthroughs among PWH, were also investigated. EXPOSURE: HIV infection. OUTCOME: COVID-19 breakthrough infections, defined as laboratory evidence of SARS-CoV-2 infection or COVID-19 diagnosis after an individual was fully vaccinated. RESULTS: Among 109,599 individuals (31,840 PWH and 77,759 PWoH), the rate of breakthrough infections was higher in PWH versus PWoH: 44 [41, 48] vs. 31 [29, 33] per 1,000 person-years. Cumulative incidence at 210 days after date fully vaccinated was low, albeit higher in PWH versus PWoH overall (2.8% versus 2.1%, log-rank p<0.001, risk difference=0.7% [0.4%, 1.0%]) and within each vaccine type. Breakthrough infection risk was 41% higher in PWH versus PWoH (aHR=1.41 [1.28, 1.56]). Among PWH, younger age (18-24 versus 45-54), history of COVID-19 prior to fully vaccinated date, and J&J vaccination (versus Pfizer) were associated with increased risk of breakthroughs. There was no association of breakthrough with HIV viral load suppression or CD4 count among PWH. CONCLUSIONS AND RELEVANCE: COVID-19 vaccination is effective against infection with SARS-CoV-2 strains circulating through 30 Sept 2021. PWH have an increased risk of breakthrough infections compared to PWoH. Recommendations for additional vaccine doses should be expanded to all PWH.","journal":"medRxiv","year":2021,"id":213732,"datarank":0.83407734066051,"base_score":2.833213344056216,"endowment":2.833213344056216,"self_citation_contribution":0.42498200160843247,"citation_network_contribution":0.40909533905207757,"self_endowment_contribution":0.42498200160843247,"citer_contribution":0.40909533905207757,"corpus_percentile":null,"corpus_rank":null,"citation_count":16,"citer_count":14,"citers_with_citation_signal":12,"citers_with_endowment":12,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.832,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":449207,"name":"Elizabeth Humes","orcid":"0000-0003-3432-7688","position":1,"is_corresponding":false},{"id":806307,"name":"Raynell Lang","orcid":"0000-0003-0268-4680","position":2,"is_corresponding":false},{"id":449211,"name":"Cameron Stewart","orcid":"0000-0002-9982-5808","position":3,"is_corresponding":false},{"id":340147,"name":"Brenna Hogan","orcid":"0000-0002-7100-8910","position":4,"is_corresponding":false},{"id":311291,"name":"Kelly A. 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Certa","orcid":"0000-0002-0176-5019","position":13,"is_corresponding":false},{"id":806310,"name":"Eric Watson","orcid":"0000-0002-1917-2748","position":14,"is_corresponding":false},{"id":807158,"name":"Celeena Jefferson","orcid":null,"position":15,"is_corresponding":false},{"id":14779,"name":"Michael J. Silverberg","orcid":"0000-0001-9322-1395","position":16,"is_corresponding":false},{"id":636517,"name":"Jacek Skarbinski","orcid":"0000-0003-1630-5733","position":17,"is_corresponding":false},{"id":421195,"name":"Wendy A. Leyden","orcid":null,"position":18,"is_corresponding":false},{"id":557883,"name":"Carolyn Williams","orcid":"0000-0002-5667-486X","position":19,"is_corresponding":false},{"id":240243,"name":"Keri N. Althoff","orcid":"0000-0002-5068-6595","position":20,"is_corresponding":false},{"id":807159,"name":"for the Corona-Infectious-Virus Epidemiology Team (CIVETs) of the NA-ACCORD of IeDEA","orcid":null,"position":21,"is_corresponding":false},{"id":375823,"name":"Sally B. 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