"HIV Center" complained to Murashko about refusals to vaccinate against COVID-19

Russians with HIV are denied vaccinations against COVID-19because of his status, the AIDS Center Foundation said. Experts say HIV is not a contraindication to vaccination

What are the problems with vaccination faced by HIV-positive people?

Russians with HIV are denied vaccination against COVID-19, although the presence of the human immunodeficiency virus is not a contraindication for vaccination, the AIDS Center Foundation complained in a letter to Health Minister Mikhail Murashko (available to RBC).

“In the context of the new coronavirus infection pandemic, the AIDS.Center fund for helping people living with HIV registers cases of discrimination against people with HIV when vaccinated <...>. The practice of refusing to vaccinate people with HIV directly contradicts medical recommendations, and first of all, the interests of patients,” the letter says.

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Of the 700 patients admitted in June by one of the doctors of the Moscow Regional Center for the Prevention and Control of AIDS, 30 people reported that they were denied vaccination because of HIV, Sergey Abdurakhmanov, director of the AIDS.Center Foundation, explained to RBC. The fund does not maintain general statistics of appeals. According to Abdurakhmanov, the number of recorded applications is only a “small layer”, since not all those who received a medical exemption on the basis of HIV infection report this to the fund.

Unreliable reports that HIV is a contraindication to receiving a vaccine can be found on the websites of some medical institutions, the letter says. The Fund suggests that the Ministry of Health send explanations to hospitals, polyclinics and vaccination points about the inadmissibility of refusing to vaccinate HIV-positive people. “We ask the Ministry of Health to additionally notify doctors about what may be the reasons for a medical withdrawal and that HIV infection is not one of them,” Abdurakhmanov explained.

The press service of the Ministry of Health told RBC that the letter from the fund has not yet been received by the department.

Cases of refusal to vaccinate due to HIV infection are isolated, but they exist, Yulia Vereshchagin, an activist of the Patient Control movement, commented to RBC. “There was a case when a person was not vaccinated, but was asked to bring permission from an infectious disease doctor. The patient had to leave, you need to go to the infectious disease specialist, and this is a waste of time, ”Vereshchagina said.

The doctor learns about HIV-positive status from the patient himself: when vaccinated, chronic diseases must be indicated in the questionnaire. “I myself spoke about the status at the inspection. After that, the doctor said that I would not be vaccinated without a certificate from an infectious disease specialist, ”one of the patients with HIV, who wished to remain anonymous, who came to the Moscow clinic for vaccination, told RBC. He turned to the manager and was only able to get the vaccine after promising to make the story public.

According to the Federal Scientific and Methodological Center for the Prevention and Control of AIDS, as of December 31, 2020, almost 1.5 million people with a confirmed diagnosis of HIV infection were registered in Russia. Last year, 72,023 new cases of HIV were detected, which is 25.9% less than in the same period in 2019. Deputy Prime Minister Tatyana Golikova said that in Russia the average HIV incidence rate is 40.77 per 100,000 people. The largest number of infected among Russians aged 30-44 years. The average age of those who died from HIV increased by a year and amounted to 39 years.

Are doctors justified in refusing to vaccinate HIV-positive people?

HIV infection is not a contraindication to vaccination against COVID-19, Aleksey Mazus, chief freelance specialist on HIV infection at the Ministry of Health, told RBC. Moreover, vaccination is indicated for HIV-positive people, he noted. “HIV-infected patients are often a particularly vulnerable group in this regard, which inevitably raises the question of the most effective preventive actions,” the expert explained.

If the immune status, that is, the level of CD4 + lymphocytes in the blood is more than 200 cells / μl, then vaccination has no restrictions. In the event that the patient has a deep immunodeficiency, then it is required to consult an infectious disease specialist to clarify the indications, Mazus notes. Vaccination in this case should be a priority, as there is a risk of severe COVID-19.

Vadim Pokrovsky, academician of the Russian Academy of Sciences, head of the Federal Scientific and Methodological Center for the Prevention and Control of AIDS, told RBC that the medical withdrawal from vaccination based on HIV infection can only be explained by the illiteracy of doctors. “In the recommendations of the Ministry of Health, HIV infection is not mentioned as a contraindication, so we can say that there is a document that indicates that this is not a basis for rejection,” he explained. Actual contraindications are severe allergic reactions, malignant blood diseases and others.

Restrictions for HIV-positive people were only during the study of the Sputnik V vaccine, Abdurakhmanov notes. According to him, this is a common practice: vulnerable groups are excluded from the tests. Since April, restrictions have been lifted, and the instructions for Sputnik V indicate that HIV infection is not a contraindication. “But doctors still put medical taps on HIV-positive people, although, on the contrary, they are at risk,” Abdurakhmanov said indignantly.

Only severe immunodeficiency can become a contraindication against vaccination against coronavirus, Pokrovsky notes. Immunodeficiency is mentioned in the recommendations of the Ministry of Health as grounds for medical withdrawal. According to Pokrovsky, with HIV infection, immunodeficiency can appear in the later stages of the disease. However, there are no disturbances in the functioning of the immune system in the early stages even if the patient is taking antiretroviral therapy. “Immunodeficiencies and HIV infection are not the same thing,” Sergey Abdurakhmanov concluded.

Doctors often refuse to vaccinate HIV-positive people based on their immune status (an indicator of the state of the immune system), explained Ekaterina Stepanova, an infectious disease specialist at H-Clinic, Candidate of Medical Sciences. However, vaccinations with "non-live vaccines", "EpiVacCorona" or "KoviVakom", do not depend on its level, she emphasizes. Restrictions on immune status exist only for "live" vaccines, when a weakened virus is introduced. “Sputnik V” penetrates the cells, but the adenovirus in it is deprived of the ability to reproduce,” so it is also safe for HIV-positive people, Stepanova explained.

“These are all baseless allegations. As a result, not only people with HIV infection, but also some people with HIV infection with a low level of immune status receive a withdrawal from vaccination. This is categorically wrong, as people with lower immune status are at risk of more severe COVID-19, as shown by the first wave of coronavirus infection, ”she warned.

What do patient organizations recommend in this situation?

Both doctors on the ground and the patients themselves do not have sufficient information, there are no uniform recommendations regarding the vaccination of HIV-infected people, Yulia Vereshchagina pointed out: “There is information that the vaccine is not contraindicated, but there is no clear gradation, for example, by immune status, viral load, comorbidities, and understanding when a person still needs to consult their doctor and when not.

Kirill Barsky, head of the programs of the Steps charitable foundation to fight AIDS, told RBC that the foundation receives dozens of requests for contraindications a week. “We explain that HIV itself is not a contraindication, and if there are concerns, it is better to contact the attending infectious disease specialist,” said Barsky.

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