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SARS-CoV-2 Reinfection Risk in Persons
with HIV, Chicago, Illinois, USA, 2020-2022
  NATAP Covid & HIV website section
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In unadjusted analyses, compared with PWOH, PWH had a higher rate (rate ratio 1.32 [95% CI 1.15-1.51]) of SARS-CoV-2 reinfection during the observation period (Table 2). After we adjusted for sociodemographic factors, region of residence, initial SARS-CoV-2 infection timing, vaccination status, vaccination type, and number of doses administered after initial SARS-CoV-2 infection, PWH had a higher rate (adjusted rate ratio 1.46 [95% CI 1.27-1.68]) of SARS-CoV-2 reinfection during the observation period compared with PWOH.
Understanding if persons with HIV (PWH) have a higher risk for SARS-CoV-2 reinfection may help tailor future COVID-19 public health guidance. To determine whether HIV infection was associated with increased risk for SARS-CoV-2 reinfection, we followed adult residents of Chicago, Illinois, USA, with SARS-CoV-2 longitudinally from their first reported infection through May 31, 2022. We matched SARS-CoV-2 laboratory data and COVID-19 vaccine administration data to Chicago’s Enhanced HIV/AIDS Reporting System. Among 453,587 Chicago residents with SARS-CoV-2, a total of 5% experienced a SARS-CoV-2 reinfection, including 192/2,886 (7%) PWH and 23,642/450,701 (5%) persons without HIV. We observed higher SARS-CoV-2 reinfection incidence rates among PWH (66 [95% CI 57-77] cases/1,000 person-years) than PWOH (50 [95% CI 49-51] cases/1,000 person-years). PWH had a higher adjusted rate of SARS-CoV-2 reinfection (1.46, 95% CI 1.27-1.68) than those without HIV. PWH should follow the recommended COVID-19 vaccine schedule, including booster doses.
This population-level analysis of matched records from different public health surveillance and information systems revealed that, among adult Chicago residents who had a reported positive SARS-CoV-2 infection, 5.3% experienced a SARS-CoV-2 reinfection during the observation period. However, incidence of SARS-CoV-2 reinfection was consistently higher among PWH than PWOH. Incidence rate differences fluctuated; differences were greater in SARS-CoV-2 reinfection incidence between PWH and PWOH occurring during periods of high citywide case rates. Moreover, after adjustment for demographic factors, residence, and COVID-19 vaccination, PWH were found to experience a higher rate of SARS-CoV-2 reinfection than were PWO
Our analysis found that SARS-CoV-2 reinfection cumulative incidence rates were higher among PWH than PWOH irrespective of most recent CD4 and viral load laboratory results. This finding indicates that even persons with well-controlled HIV infection might have a higher risk for SARS-CoV-2 reinfection compared with PWOH. We observed the highest cumulative incidence rates among PWH with a most recent HIV viral load laboratory result >200 copies/mL and CD4 laboratory result <200 cells/mm3, indicating that PWH with laboratory evidence consistent with uncontrolled HIV are at greatest risk for multiple SARS-CoV-2 infections. Similarly, PWH with a history of AIDS had a higher cumulative risk for reinfection, followed by PWH without AIDS; PWOH had the lowest cumulative incidence across the 3 strata. Persons who are immunocompromised are at increased risk for severe COVID-19 illness and death; their immune response to COVID-19 vaccination may not be as strong as in persons who are not immunocompromised. Guidance from the Centers for Disease Control and Prevention recommends that persons with advanced or untreated HIV receive an additional COVID-19 vaccine dose to complete a primary series and receive a booster (38,39). However, our analysis also indicated that PWH with high CD4 counts, no evidence of a prior AIDS diagnosis, and viral suppression are also at higher risk for SARS-CoV-2 reinfection than PWOH. Additional studies are needed to understand if those with well-controlled HIV also require additional COVID-19 vaccine doses.

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