by Mike Andrew - SGN Staff Writer

While scientific opinion seems to say that COVID-19 vaccines are safe for people living with HIV, it's not clear when vaccines will be available to that population.

If many HIV/AIDS advocates have their way, HIV-positive people - regardless of their degree of viral suppression - will be among the first groups to be immunized.

But where everyone falls in line is not at all right now, given the complex calculations involving age, job risks, and underlying health conditions. Adding to the uncertainty is the fact that decisions will ultimately be left to individual states and county health departments.

It is not even clear how many doses of the vaccine will be available and when.

The Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP) has been developing guidelines for state and county health departments on which groups should be prioritized for the COVID-19 vaccines.

In guidelines released in December, the ACIP said that nursing home residents and healthcare workers should get first priority, followed by people over the age of 65 or with underlying medical conditions that put them at high risk of complications from COVID-19.

The ACIP didn't specify which medical conditions put people at risk of COVID-19 complications, however. It might provide more clarity in its January meetings. Until then, advocates for people with chronic health concerns, including HIV, have begun lobbying to move as close to the front of the line as possible.

Activists push to prioritize HIV-positive people
Just after the FDA issued its emergency authorization for the Pfizer-BioNTech vaccine, a coalition of HIV advocacy organizations sent a letter to the CDC and congressional leaders asking that people living with HIV be considered a priority group for COVID-19 vaccination.

The letter, initiated by AIDS Action Baltimore and signed by more than a dozen groups, including the Latino Commission on AIDS, NASTAD, and the Treatment Action Group, said that recent studies "suggest approximately a doubling risk of hospitalization and death from COVID-19 among people living with HIV compared to HIV-negative counterparts."

Even with some evidence suggesting that people with HIV - including those with an undetectable viral load and absent comorbidities, such as diabetes - may be at a heightened risk of worse COVID-19 outcomes, the fact remains there is no scientific consensus, in part because several other studies have shown no increased risk caused by HIV.

Lynda Dee, executive director of AIDS Action Baltimore, says she doesn't want to risk the health of any HIV-positive people and feels it's inappropriate to distinguish between people with or without an undetectable viral load during a deadly global pandemic.

"People with HIV have done so much and worked so hard to be undetectable and stay there," said Dee. "They need to be included in the CDC's prioritization."

Dee, who fought to get people with HIV included in the Pfizer-BioNTech trials, added that her intent is not to compete with other groups who are advocating for their own community but "to do what we've been doing: knock on the door and let them know we're here."

Murray Penner, the US executive director of the Prevention Access Campaign, agrees that even though the verdict is still out on whether HIV itself is a marker for COVID-19 complications, the ACIP and state health departments should prioritize all people with HIV.

"I don't believe there is definitive research about whether having an undetectable viral load reduces that risk, and so, therefore, we are advocating that everyone living with HIV be prioritized - but those with comorbidities be stratified higher, if that's possible," he said.