Staying up to date on the latest information about COVID-19 has been difficult throughout the pandemic. Public health guidance has shifted as we gain more knowledge about the virus that causes COVID-19. Some people have questions about whether people living with HIV require a third dose of the COVID-19 vaccine. As part of the partnership between the CIHR Canadian HIV Trials Network (CTN) and CATIE, we have put together a living document to provide the latest information on COVID-19 vaccination third doses for people living with HIV across Canada. For more information on COVID-19 vaccines, please visit www.catie.ca/covid-19-faq.

How do COVID-19 vaccines work?

The vaccines work by teaching your body’s immune system to recognize the virus that causes COVID-19. This allows your body to fight off the virus if it ever encounters it. Vaccines can reduce the severity of disease if you become infected, and they may also help to prevent transmission of the virus to others.

For people who don’t develop the same immune response to two doses of the vaccine, a third dose is needed to get a similar level of protection as other people.

HIV and COVID-19 vaccines

It is important to consider getting vaccinated if you have HIV. Many people with HIV have or are at an increased risk for developing the underlying conditions that increase their chances of severe disease if they become infected with the virus that causes COVID-19. These underlying conditions include high blood pressure, diabetes, high cholesterol levels, lung disease, and obesity.

Experts consider COVID-19 vaccines to be safe and effective for people with HIV. Clinical trials with the Moderna, Pfizer-BioNTech, and AstraZeneca vaccines included a relatively small number of people with HIV, all of whom were taking ART and who were healthy and well. Further studies are needed to determine if the vaccines work as well for people with HIV as they do for the general population.

There is no information yet on how well the vaccine works in people living with HIV who have a compromised immune system.

Because of changes to their immune systems, people living with HIV tend to have weaker immune responses to some vaccines, such as the influenza, hepatitis A and B, and human papillomavirus (HPV) vaccines. Past research also suggests that when people living with HIV are vaccinated against some diseases, their immune responses don’t last as long as for others. For COVID-19 vaccines, limited information is beginning to appear about safety and effectiveness in people living with HIV who are taking ART and who have an undetectable viral load. The data suggest that COVID-19 vaccines are generally safe with similar side effects as in HIV-negative people. Preliminary CTN results also suggest that, after receiving two doses, the antibody response of people living with HIV was similar to people without HIV.

However, there is no information yet on how well the vaccine works in people living with HIV who have a compromised immune system. If you are not on treatment and have a very low CD4 count, discuss vaccination with your healthcare provider. Some experts recommend starting HIV treatment first to prevent HIV-related complications and to potentially improve vaccine effectiveness.

Booster doses

Current evidence suggests that for most people, including people living with HIV, receiving two doses of the vaccine creates an initial immune response that is strong enough to effectively reduce the risk of developing COVID-19 or related serious illness. Today, most adults are eligible for a third dose and some may be eligible for fourth and fifth doses. These doses are sometimes referred to as

“booster” doses. Boosters are additional doses that “boost” protection after the immune response from the initial two-dose vaccine decreases over time; in Canada, a COVID-19 booster dose is available 3–6 months after the primary dose, depending on the province or territory. Follow the links to learn more about Moderna and Pfizer–BioNTech booster doses in Canada.

People ages 5 years and older, including children and youth living with HIV, are also eligible for COVID-19 vaccination across Canada. For children between 5 years and 11 years of age, the dose provided is lower than for ages 12+.

Third dose as part of the primary COVID-19 vaccination series

Unlike a booster dose, people living with advanced or untreated HIV are eligible for a third dose much sooner than 6 months in many regions across Canada. For these people and others who don’t develop the same immune response to two doses of the vaccine, a third dose is included as part of the primary series of vaccinations needed to get a similar level of protection as other people. Talk with your healthcare provider to ask if a third dose is right for you! You can also view the current guidance document from the Public Health Agency of Canada here.

People living with HIV who are immunocompromised are also eligible for a booster dose on top of their three-dose series (i.e., a fourth dose). A booster dose is available 3–6 months after the third dose, depending on the province or territory. See When can I get my booster? for more information.

Information current as of May 6, 2022

Am I eligible for a third COVID-19 vaccine dose?

Some public health authorities have recommended a third dose of the COVID-19 vaccine for a small minority of people living with HIV who have untreated infection or are severely immunocompromised.

Learn More About Regional Guidelines

Across Canada, people are currently eligible for a third dose as part of their primary vaccination series if they are both at high risk of an inadequate response to two doses and of severe disease or death if they are infected.

Some public health authorities have recommended a third dose of the COVID-19 vaccine for a small minority of people living with HIV who have untreated infection or are severely immunocompromised. This does not apply to the majority of people living with HIV in Canada. If you have any questions about your own medical situation, please consult your healthcare provider.

Only a few provinces provide clear criteria for what they consider to be uncontrolled:

    • Quebec recommends a third dose for those with CD4 count below 500/mm3, or who are not on treatment.
    • Saskatchewan and Nova Scotia recommend one for those below 200/mm3.
    • British Columbia provides a detailed list of criteria for those who are eligible: prior AIDS defining illness since 2021 or prior CD4 count ≤ 200/mm3 since 2021 or prior CD4 fraction ≤ 15% (percentage of white blood cells that are CD4 cells) since 2021 or any detectable plasma viral load since January 2021 or living with HIV and 65 years or older or HIV acquired at or around birth.
    • Ontario recommends a three-dose primary series for people living with HIV who have experienced prior AIDS defining illness or prior CD4 count ≤ 200/mm3 or prior CD4 fraction ≤ 15% (percentage of white blood cells that are CD4 cells) or (in children 5–11 years) HIV acquired at birth.

In Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nunavut, Prince Edward Island, and the Yukon, people with untreated or advanced HIV, or AIDS, are eligible for a third dose. Advanced HIV or AIDS is generally diagnosed when CD4 count is below 200/mm3 (though it can occur at higher CD4 counts), CD4 fraction (percentage of white blood cells that are CD4 cells) is less than 14%, or an AIDS-defining illness has occurred.

In many places across Canada, age, Indigenous ethinicity, and underlying medical conditions can also play a roll in accessing additional doses sooner. Check the links above to learn more about the details for your region.

If I am eligible for a third dose, when can I get it?

Most of the provinces require a minimum amount of time between the second and third dose.

Learn More About Regional Guidelines

Most of the provinces require a minimum amount of time between the second and third dose. But, as with the timing between the first and second dose, a shorter interval between doses does not necessarily produce a better immune response. We do not yet know the optimal length of time between doses; this decision should be made in collaboration with your health care provider.

Alberta residents must wait at least 8 weeks after their second dose. Ontario requires a waiting period of 4 weeks but recommends at least 8 weeks after the second dose.

Quebec, Saskatchewan, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Nunavut, Prince Edward Island, and the Yukon require a minimum waiting period of 4 weeks between second and third doses.

Northwest Territories requires a minimum waiting period of 3 weeks for Pfizer and 4 weeks for Moderna.

When can I get my first or second booster?

Everyone 18 years or older is eligible for a booster and many are eligible for a second booster.

Learn More About Regional Guidelines

In all provinces and territories, those who are considered to be clinically vulnerable (see Am I eligible for a third COVID-19 vaccine dose? above), are eligible for a first and a second booster dose after their primary series. For those that are not immunocompromised, everyone 18 years or older is eligible for a booster and many are eligible for a second booster.

People 18+ are eligible for a booster dose in:

  • Alberta: First booster is available 5 months after last dose. Second boosters are available for: a) everyone 70 years and older, b) Indigenous people aged 65 and older, c) all seniors receiving care in congregate living contexts.
  • British Columbia: First booster is available 6 months after last dose; pregnant people can get a booster 8 weeks after last dose. Second boosters are available for: a) everyone 70 years or older, b) residents in long-term care, c) Indigenous people 55 years and older.
  • Manitoba: First booster is available 5 months after last dose for people 50+ or 18+ who live in First Nations communities; 6 months after last dose for everyone else. Second boosters are available for a) anyone in congregate living centres or care homes regardless of age, b) seniors older than 70 living anywhere, c) Indigenous people aged 50 or older, living anywhere.
  • New Brunswick: First booster is available 5 months after last dose. Second boosters are available for a) anyone 70 years or older b) anyone in long-term care, c) Indigenous people aged 18 and older, any New Brunswick resident aged 50 and older.
  • Newfoundland & Labrador: First booster is available 5 months (154 days) after last dose. Second boosters are available after 20 weeks post first booster for a) anyone 70 years or older, b) anyone residing in congregate living, c) any Indigenous person aged 18 years or older, d) anyone living in a remote Indigenous community who is 18 years or older.
  • Northwest Territories: First booster is available 6 months after last dose. Second boosters are available for a) anyone 70 years or older, b) residents of long-term care who are 60 years or older, immunocompromised people aged 12 years or older.
  • Nova Scotia: First booster is available 5.5 months (24 weeks) after last dose. Second boosters are available 120 days after the first booster for a) anyone 70 years or older, b) residents of long-term care or home licensed under the Homes for Special Care Act.
  • Nunavut: First booster is available 4.5 months after last dose. Second boosters are available 4.5 months after the first booster for anyone aged 50 years or older.
  • Ontario: First booster is available 3 months after last dose. Second boosters are available 5 months after the last dose for a) anyone 60 years or older b) anyone at least 18 years old who is part of an Indigenous household (including Indigenous and non-Indigenous people). Second bosters are available three months after the last dose for long-term care residents, elder care lodge residents, retirement home residents, and older adults in congregate living.
  • Prince Edward Island: First booster is available 6 months after last dose. Second boosters are available for those living in congregate living facilities, those who are aged 70 years or older, and any Indigenous person aged 18 or older.
  • Quebec: First booster is available 3 months after last dose.
  • Saskatchewan: First booster is available 4 months after last dose for anyone 12 and older. Second boosters are available 4 months after the last dose for anyone aged 50 and older.
  • Yukon: First booster is available 6 months after last dose. Second boosters are available 6 months after the last dose for Yukon residents aged 70 and up and seniors in any long-term care facility.

What if I'm younger than 18?

Across Canada, everyone 5+ is eligible for a two-dose series of COVID-19 vaccine.

Learn more about vaccines for youth & young adults

Across Canada, everyone 5+ is eligible for a two-dose series of COVID-19 vaccine. For people 5+ who are moderately to severely immunocompromised, a three-dose series of vaccines is available in all provinces and territories. In Ontario and British Columbia, children who acquired HIV at our around birth are generally considered to be immunocompromised — the other provinces do not provide details about how they categorize this group of people.

In the Northwest Territories, a booster is available for immunocompromised people 12 years of age or older.

The interval between the last dose of the primary vaccine series and the booster dose is generally the same for youth and adolescents as it is for adults. In Ontario, it is recommended that people 12+ wait 6 months, but they can get their booster after 3 months with informed consent. In Nunavut, people aged 12–17 can get their booster 6 months after their primary series (4.5 months for 18+).

Boosters for people who are immunocompromised & who received 3 doses of the vaccine

The time between the third dose and the booster varies by province and territory.

Learn more

Immunocompromised individuals that received three doses of the COVID-19 vaccine series can also obtain a first booster dose and a second booster dose (five total doses). The time between the third dose and the booster varies by province and territory. Please find more information via the links by province and territory, above.

How do I get my next dose?

Each province has slightly different methods of booking additional doses.

Learn More About Regional Guidelines

Eligible people in:

  • Alberta: can call Health Link at 811, book online with AHS or a participating pharmacy, or contact a physician’s office. Individuals aged 65 and older who live on a First Nations reserve will be able to vaccines through local public health clinics on-reserve.
  • British Columbia: will be contacted through the Get Vaccinated system. If you believe you meet the criteria to get a third dose and have not been contacted yet, talk to your health care provider.
  • Manitoba: can get their doses at COVID-19 clinics (prescription from a licensed physician required) and some medical clinics and community pharmacies.
  • New Brunswick: can register online or by phone through a Regional Health Authority or participating pharmacy.
  • Newfoundland & Labrador: can book an appointment at a Regional Health Authority clinic (select “Second Dose” when booking online), or contact their physician or pharmacist.
  • Northwest Territories: can schedule an appointment through their local health centres or in Yellowknife by booking an appointment online.
  • Nova Scotia: can book online or by phone.
  • Nunavut: can call a health centre to make an appointment or visit Iqaluit Public Health on weekdays for Moderna (ages 18+) and Wednesday for Pfizer (ages 12 to 17).
  • Ontario: will be contacted by their health care provider when they are eligible to receive the vaccine. Care provider may be able to submit referral form for eligible patients.
  • Prince Edward Island: can book an appointment at either a COVID-19 Vaccine Clinic or from a participating pharmacy.
  • Quebec: can make an appointment online by selecting “COVID-19 Vaccine – 3rd dose” on the appointment platform.
  • Saskatchewan: will receive a letter from the Ministry of Health or their physician with instructions. You must bring the letter to vaccine appointment.
  • Yukon: can make an appointment online through the CanImmunize page on ca.

 

If you are unsure about whether you are eligible for a third dose, are uncomfortable about additional doses, or are unable to schedule an appointment, talk to your health care provider.

For a collection of resources on COVID-19, please visit here. For more about ongoing research in COVID-19 in people living with HIV, please visit here.

Note: This is a living document and it will be updated as more information becomes available. If you notice something that is out of date, please contact CTNinfo@hivnet.ubc.ca.