South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC.
Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC.
J Acquir Immune Defic Syndr. 2024 Oct 1;97(2):107-116. doi: 10.1097/QAI.0000000000003475.
This study aims to identify COVID-19 breakthrough infections among people with HIV (PWH) across different phases of the pandemic and explore whether differential immune dysfunctions are associated with breakthrough infections.
This retrospective population-based cohort study used data from an integrated electronic health record (EHR) database in South Carolina (SC). Breakthrough infection was defined as the first COVID-19 diagnosis documented in the state agency after the date an individual was fully vaccinated (ie, 2 doses of Pfizer/BNT162b2 or Moderna/mRNA-1273, or 1 dose of Janssen/Ad26.COV2.S) through June 14, 2022. We analyzed the risk and associated factors of the outcome using Cox proportional hazards models.
Among 7596 fully vaccinated PWH, the overall rate of breakthrough infections was 118.95 cases per 1000 person-years. When compared with the alpha-dominant period, the breakthrough infection rate was higher during both delta-dominant (HR: 1.50; 95% CI: 1.25 to 1.81) and omicron-dominant (HR: 2.86; 95% CI: 1.73 to 4.73) periods. Individuals who received a booster dose had a lower likelihood of breakthrough infections (HR: 0.19; 95% CI: 0.15 to 0.24). There was no association of breakthrough infections with degree of HIV viral suppression, but a higher CD4 count was significantly associated with fewer breakthroughs among PWH (>500 vs <200 cells/mm3: HR: 0.68; 95% CI: 0.49 to 0.94).
In our PWH population, the incidence of breakthrough infections was high (during both delta-dominant and omicron-dominant periods) and mainly associated with the absence of a booster dose in patients older than 50 years, with comorbidities and low CD4 count.
本研究旨在确定不同大流行阶段艾滋病毒感染者（PLWH）中的 COVID-19 突破性感染，并探讨是否存在不同的免疫功能障碍与突破性感染有关。
这项回顾性基于人群的队列研究使用了南卡罗来纳州（SC）综合电子健康记录（EHR）数据库中的数据。突破性感染的定义是在个人完全接种疫苗（即 Pfizer/BNT162b2 或 Moderna/mRNA-1273 的 2 剂，或 Janssen/Ad26.COV2.S 的 1 剂）后，州机构记录的首次 COVID-19 诊断，截至 2022 年 6 月 14 日。我们使用 Cox 比例风险模型分析了结局的风险和相关因素。
在 7596 名完全接种疫苗的 PLWH 中，突破性感染的总体发生率为每 1000 人年 118.95 例。与阿尔法主导期相比，德尔塔主导期（HR：1.50；95%CI：1.25 至 1.81）和奥密克戎主导期（HR：2.86；95%CI：1.73 至 4.73）的突破性感染率更高。接受加强剂量的个体发生突破性感染的可能性较低（HR：0.19；95%CI：0.15 至 0.24）。突破性感染与 HIV 病毒抑制程度无关，但较高的 CD4 计数与 PLWH 中较少的突破性感染显著相关（>500 与<200 个细胞/mm3：HR：0.68；95%CI：0.49 至 0.94）。
在我们的 PLWH 人群中，突破性感染的发生率很高（在德尔塔主导期和奥密克戎主导期都很高），主要与 50 岁以上患者未接种加强剂量、合并症和低 CD4 计数有关。
