The BC Centre for Excellence in HIV/AIDS (BC-CfE) Committee for Drug Evaluation and Therapy (CDET) recently completed its evaluation of all of the available data regarding the use of Pfizer and Moderna COVID-19 mRNA vaccines for persons living with HIV (PLWH).
Based on the committee’s expert opinion, the BC-CfE supports the use of Pfizer and Moderna COVID-19 mRNA vaccines to protect PLWH aged 18 years or older against COVID-19 related disease, if they meet current public health criteria for priority groups and if they have no contraindications to the product.
Health Canada said the two COVID-19 vaccines it has so far approved are safe, effective and will save lives. In explaining the efficacy of the vaccines, Health Canada said, “Vaccines do more than protect the people getting vaccinated, they also protect everyone around them. The more people in a community who are vaccinated and protected from COVID-19, the harder it is for the virus to spread.”
Both Pfizer and Moderna vaccines are the mRNA type. This kind of vaccine, according to Health Canada, “teach our cells how to make a protein that will trigger an immune response without using the live virus that causes COVID-19. Once triggered, our body then makes antibodies. These antibodies help us fight the infection if the real virus does enter our body in the future.”
Although data for use of the mRNA vaccines in PLWH is limited, CDET expects similar vaccine responses to those without HIV. These mRNA vaccines are not known to be associated with more serious adverse events amongst immunocompromised individuals, however, it should be noted immune response may potentially be sub-optimal in those that are immunocompromised. PLWH on antiretroviral therapy with an undetectable HIV plasma viral load and CD4 count above 200 cells per cubic millimeter of blood (cells/mm3) are likely to have an intact immune response.
CD4 cells are a type of white blood cell which play a key role in the immune system and when a person is living with HIV the virus attacks the CD4 cells in their blood. A healthy immune system normally has a CD4 count ranging from 500 to 1,600 cells/mm3.
The efficacy and safety of Pfizer and Moderna COVID-19 mRNA vaccines is less clear amongst individuals with a detectable HIV plasma viral load or CD4 count below 200 cells/mm3. This is because PLWH who met these criteria were not included in these vaccine studies. CDET says these individuals may be offered the vaccine after risk/benefit counselling under the guidance of experienced health practitioners.
B.C.’s vaccination strategy has been developed based on recommendations from the National Advisory Committee on Immunization (NACI). The strategy is focused on protecting those most vulnerable to severe illness first.
The first groups to get vaccinated between December and February include: residents, staff, and essential visitors to long-term care and assisted-living residences; those in hospital or community awaiting a long-term care placement; health care workers providing care for COVID-19 patients; and remote and isolated Indigenous communities.
Starting next month until March, the immunization program will expand to include many groups the BC-CfE serves. These include: seniors, age 80 and above; Indigenous (First Nations, Métis and Inuit) seniors, age 65 and above; people experiencing homelessness and/or using shelters; provincial correctional facilities; adults in group homes or mental health residential care; long term home support recipients and staff; hospital staff, community GPs and medical specialists; and other Indigenous communities not vaccinated in first priority group.
BC’s Provincial Health Officer Dr. Bonnie Henry says achieving herd immunity will become more of a government priority during the spring. This will be when more doses of the Pfizer and Moderna vaccines are available and two more COVID-19 vaccines are approved by Health Canada.
As the government of BC says, “Herd immunity could be reached once 60 to 70% of the population is vaccinated. When people in British Columbia decide to get the COVID-19 vaccine, they are not only protecting themselves from the virus, they are also protecting everyone around them. If a majority of British Columbians get the COVID-19 vaccine, this would reduce transmission rapidly.”