Important update: See below the latest guidance regarding vaccinations for people living with HIV with lower CD4 counts.

COVID-19 vaccination recommended for all people living with HIV

Last updated Thursday 10 February 2022

All people living with HIV, aged 12 years or older can now access a COVID-19 vaccine. The Pfizer vaccine is the COVID-19 vaccine being used in New Zealand. Evidence shows that COVID-19 vaccines are safe for people living with HIV. 

The COVID-19 vaccine lowers the risk of infection and if an infection does occur, the vaccine will likely shorten the period of illness and reduce the severity of symptoms.  The vaccine may also reduce the chance of the virus spreading to others.

Each district health board (DHB) around New Zealand is managing the rollout of the vaccine in their area. For more information go to the COVID-19 website or contact Healthline on 0800 358 5453.

Auckland District Health Board has recently released a very informative document about the Pfizer COVID-19 vaccination advice for people living with HIV.

Guidance on Third COVID-19 Vaccine Dose for people living with HIV with Low CD4 cell counts

The Ministry of Health recommends that people living with HIV or AIDS who had a CD4 count less than 200 cells/µl at the time of initial vaccination receive a third dose of the vaccine for COVID-19. People with very low CD4 cell counts and other severely immunocompromised people may have suboptimal immune responses to the initial course of COVID-19 vaccinations such that they are not adequately protected. Therefore, a third dose of the vaccine is recommended to improve immune protection.

The third dose is part of the primary vaccination course intended to build immunity among those who may not have adequately responded to the first and second dose. The additional dose should be administered at least 8 weeks after the second dose. Reactions reported after a third dose of the vaccine are usually mild and similar to those reported after the second dose. These include fatigue and soreness at the injection site, reported as mild to moderate for most people.

A third dose of the vaccine is different from a booster. Boosters are targeted for people who have already received their full course of vaccination, but whose immunity may wane over time. Boosters are available in New Zealand for anyone aged 18 or over who completed their primary COVID-19 vaccination course at least 3 months ago. Burnett Foundation Aotearoa strongly encourages people living with HIV to book their booster vaccines as soon as they are eligible.

If you are living with HIV and you believe you may have had a CD4 cell count of less than 200 cells/µl at the time of your initial vaccination course, it is important that you take steps to ensure adequate protection from COVID-19. We know people living with HIV, and especially those with low CD4 cell counts, may be at increased risk of severe COVID-19 disease. The third dose must be prescribed by a medical practitioner. Please talk to your HIV specialist or GP about receiving a third dose.

People living with HIV may be at risk of poorer outcomes following COVID-19 infection

The current scientific consensus is that people living with HIV may be at increased risk of COVID-19 infection and of poorer outcomes following COVID-19. This is supported by existing cohort studies and case series. Some of the findings suggest that PLHIV may be at increased risk of hospitalisation or death as a result of COVID-19 infection. 

Different factors may underlie these associations, including the effects of HIV infection on the immune system, potential interplay between the two viruses, increased presence of comorbidities, advanced age, and other factors. It remains unclear to what extent any of these factors contribute to the level of risk.  

British HIV Association position statement emphasises that these risks are likely more pronounced in the cases of either uncontrolled HIV infection or advanced immunodeficiency, or in the context of additional comorbidities.