Health oversight agencies in the United States say that the COVID-19 vaccine is safe, even for those with conditions involving compromised immunity, such as HIV.

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According to the National Institutes of Health (NIH), people with HIV should receive the COVID-19 vaccine. The vaccine does not interfere with HIV medications, and no evidence suggests that it causes more side effects in people with HIV than in other people.

In most cases, the Centers for Disease Control and Prevention (CDC) recommend the Pfizer-BioNTech or Moderna vaccines over Johnson & Johnson’s Janssen shot.

This article discusses the COVID-19 vaccine and HIV in regard to the effects and risks. It also looks at whether experts advise getting a booster and examines the dangers involved when a person with HIV develops COVID-19.

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As the potential benefits of the COVID-19 vaccine outweigh the risks, health experts advise people with HIV to get it. The NIH advises people to get the vaccine regardless of their viral load and CD4 count.

In people with HIV, the viral load refers to the number of HIV viral particles in their blood. The CD4 count is a measurement of infection-fighting white blood cells. Doctors use these metrics to monitor the immunity of someone with HIV.

There is currently no evidence indicating that the COVID-19 vaccine interacts with HIV antiretroviral drugs. Additionally, no studies suggest that the vaccine has any harmful interactions with pre-exposure prophylaxis, also called PrEP. These drugs help prevent HIV infection in people with an increased risk.

Researchers are studying the effect of the various COVID-19 vaccines on individuals with HIV. To date, no evidence indicates that people with the virus have more side effects than other people.

Common side effects in all individuals include:

  • pain and swelling at the injection site
  • headaches
  • tiredness
  • fever

Three COVID-19 vaccines are available in the U.S.

The Pfizer-BioNTech and Moderna vaccines are based on modified messenger RNA-containing vaccines, known as mRNA vaccines. These work by teaching the body’s cells to trigger an immune response when they come into contact with a particular virus.

The third vaccine option, the Janssen vaccine, is a viral vector vaccine. It uses a modified version of a harmless virus to trigger an immune response.

In most situations, the CDC recommends either the Pfizer-BioNTech or Moderna vaccine over the Janssen vaccine.

According to the CDC, everyone — including those with HIV — should get a booster vaccine.

The organization also says that people with advanced HIV, including AIDS, and those who are not taking HIV medication should receive an additional primary shot. After that, they are eligible for a booster.

Doctors define advanced HIV as having:

  • CD4 counts of fewer than 200 cells per cubic millimeter
  • clinical signs and symptoms
  • a history of an AIDS-defining condition without repairing the body’s immune function

Before getting any vaccine, people should make sure that they understand the risks, the contraindications, and the potential for medication interactions.

Risks

The risks of the Pfizer-BioNTech and Moderna vaccines differ from those of the Janssen vaccine.

Pfizer-BioNTech and Moderna vaccines

There have been rare reports of serious allergic reactions, according to the Infectious Diseases Society of America (IDSA). People who get the Pfizer-BioNTech or Moderna vaccines should receive monitoring for at least 15 minutes after getting the shot and at least 30 minutes if they have a history of allergic reactions.

These vaccines are also associated with a very small risk of myocarditis, which is inflammation of the heart muscle. This condition can impair the heart’s ability to pump. However, a person has a higher chance of getting myocarditis from COVID-19 than from the vaccine.

It may be difficult to tell the difference between allergic reactions and myocarditis. Symptoms of the latter include:

  • shortness of breath
  • chest pain
  • fluttering or pounding heartbeats

A person should contact a doctor if they experience these symptoms.

Janssen vaccine

According to the IDSA, fewer than 2 in 1 million people who have had the Janssen vaccine have experienced serious blood clotting disorders, such as thrombosis with thrombocytopenia syndrome (TTS), or the neurological condition Guillain-Barré syndrome.

As of February 10, 2022, healthcare professionals in the U.S. have delivered more than 18.2 million doses of the Janssen vaccine. Among these, the CDC and the Food and Drug Administration (FDA) have identified 57 cases of TTS, nine of which led to death. This means that despite the severity of the condition, it is highly unlikely to occur.

These organizations also identified 310 cases of Guillain-Barré syndrome, making it another rare side effect. It is possible to make a full recovery from this condition. The symptoms that may occur within 42 days of getting the vaccine include:

  • tingling or weakness in the arms or legs
  • difficulty speaking, chewing, or swallowing
  • difficulty walking
  • double vision
  • difficulty controlling bowel and bladder functions

Contraindications

Below are the contraindications that the CDC lists for the three vaccines. A person should not receive a COVID-19 vaccine if they have:

  • had a severe allergic reaction to a previous vaccine
  • received a diagnosis of an allergy to a component of a COVID-19 vaccine
  • experienced a blood clot with low platelets in response to the Janssen vaccine or a similar vaccine that has not received authorization in the U.S.

Medication interactions

The National Foundation for Infectious Diseases (NFID) notes that COVID-19 vaccines do not interfere with most prescription and over-the-counter (OTC) medications.

However, the NFID recommends not taking a pain reliever or fever-reducing drug before getting the vaccine, as this could suppress the body’s immune response. If someone has a reaction after receiving the vaccine, they are safe to take OTC drugs.

Many people with HIV have one or more additional conditions that may increase their risk of severe COVID-19. According to the International AIDS Society (IAS), these individuals and those who are not taking treatment as prescribed have an increased likelihood of hospitalizations and death.

If someone with HIV gets a SARS-CoV-2 infection, which can cause COVID-19, experts recommend close monitoring. This is especially important if the person has advanced HIV or accompanying health conditions.

People with low CD4 cell counts, advanced HIV disease, or both are more susceptible to severe illness from COVID-19. Consequently, those with HIV should take care to take their antiretroviral medication regularly. Doing so will help keep their immune system functioning as well as possible.

Individuals living with HIV should also follow the nonmedicinal interventions to reduce exposure and risk, including:

  • washing the hands thoroughly and frequently
  • keeping a physical distance from others, especially those who are sick
  • wearing a mask

A person with HIV should make the person administering the COVID-19 vaccine aware of this. One reason for this is that the COVID-19 vaccine guidelines differ slightly for people with HIV.

While the waiting time between the second dose and booster is 5 months for the general population, it is 28 days for someone with HIV.

Additionally, recommendations for boosters in people with HIV depend on the person’s viral load and the strength of their immune system. Blood tests that measure viral load and immunity may be necessary beforehand to determine whether they need a booster and, if so, which one is best.

People with HIV should also tell the person administering the COVID-19 vaccine if they have any allergies or other health conditions.

The NIH has issued clear recommendations concerning the COVID-19 vaccine and HIV. It advises people with HIV to get the vaccine regardless of their viral load or CD4 count.

As many individuals with HIV have one or more accompanying conditions that increase their risk of having a serious case of COVID-19, the benefits of the shot outweigh the risks.