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 can also help to prevent transmission of the virus to others.

Current evidence suggests that for most people, receiving two doses of the vaccine creates a strong enough immune response to effectively reduce the risk of developing COVID-19 or related serious illness. 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. A third dose is not the same as a booster dose, which is an additional dose that “boosts” protection after the immune response from the initial two-dose vaccine decreases over time.

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 developing COVID-19 or 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.

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.

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

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.

 

Information current as of November 22, 2021

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 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 is the only province that provides a detailed list of criteria for those who are eligible: 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 any detectable plasma viral load since January 2021 or living with HIV and 65 years or older or HIV acquired at or around birth.

In Alberta, Ontario, 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.

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.

How do I get my third dose?

Each province has slightly different methods of booking third 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 access third doses 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 third dose 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 for a third COVID-19 vaccination 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 a third dose 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 to receive the third dose of the vaccine 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.