FAQs for clinicians about covid-19 vaccines and people living with HIV

ASHM COVID-19 Taskforce interim recommendations 


Prepared by members of the ASHM COVID-19 Taskforce Members


UPDATED ON: 14 April 2021.

ATAGI has recommended that:

  • the COVID-19 Pfizer vaccine be preferred over AstraZeneca for adults aged under 50 years. This is because there is a potentially higher risk of thrombosis with thrombocytopenia in people aged under 50, who receive the AstraZeneca vaccine
  • the AstraZeneca vaccine be used in adults aged under 50, if the benefits outweigh the risks for that person – and they have made an informed decision based on the risks and benefits
  • people who have had the first dose of AstraZeneca without any serious adverse effects, can be given the second dose. This includes people aged under 50.


Healthcare providers may wish to continue having detailed discussions with patients about the risks and benefits of the AstraZeneca vaccine in line with ATAGI advice, regardless of the age of the patient, ensuring fully informed consent before vaccination.

Updated safety advisory – rare and unusual blood clotting syndrome (thrombosis with thrombocytopaenia): https://www.tga.gov.au/media-release/astrazeneca-chadox1-s-covid-19-vaccine



A number of studies to date have shown that people living with HIV (PLWHIV) appear to be at increased risk of infection with SARS-CoV-2 and at increased risk for poorer outcomes following infection with SARS-CoV-2. 

The ASHM COVID-19 Taskforce recommends the following with respect to the provision of COVID-19 vaccines to PLWHIV in Australia:


• The Pfizer-BioNTech BNT162b2 mRNA vaccine (COMIRNATY) for people ≥16 years of age [1]

• The AstraZeneca ChAdOx1 nCoV-19 (AZD 1222) vaccine for people ≥18 years of age [2].See ATAGI related guidance at the top of this page

• Yes [3]

• Yes [4] In a 9 April 2021 media release, the WHO recommended that people living with HIV be prioritised for early vaccination. The WHO state that people living with HIV are at greater risk of poorer outcomes [4] from COVID-19 infection. This is in line with the Statement from the ASHM COVID-19 Taskforce regarding the Prioritisation of COVID-19 Vaccines for People Living with HIV

• Yes [5]
• Age is the only eligibility criterion that restricts access to these vaccines:

     o Pfizer-BioNTech vaccine: ≥16 years

     o AstraZeneca vaccine: ≥18 years. See ATAGI related guidance at the top of this page

• Otherwise, all people living with HIV (PLWHIV) are eligible for these vaccines irrespective of whether they have a Medicare number, whether they are here on temporary visas, whether they are incarcerated, homeless or in migrant detention centres [5]


• Yes, if they have no contraindications to these vaccines [3] See notes above

• Yes

• The COVID-19 vaccine roll-out is an excellent opportunity to recommend testing for HIV, blood-borne viruses and STIs to all people who are sexually active and to people who may have been exposed to HIV, viral hepatitis and STIs in the past

• HIV-positive people can receive a vaccine if they meet Phase 1a eligibility criteria

• All other HIV-positive people will be eligible to receive a vaccine during Phase 1b

• HIV-positive people will qualify to receive COVID-19 vaccines during Phase 1a if they are quarantine or border workers, frontline healthcare workers, aged care and disability care staff, or aged care and disability care residents [6]

• These criteria alone should be sufficient for HIV-positive patients to be offered a COVID-19 vaccine and their HIV status should not have to be cited as a reason to be vaccinated

• HIV-positive people will qualify to receive COVID-19 vaccines during Phase 1b if they are [6]
     o A critical and high-risk worker
     o Indigenous and ≥ 55 years of age
     o Non-Indigenous and ≥ 70 years of age
     o A younger adult with an underlying medical condition or a disability
NOTE: HIV infection is one of the criteria listed as an underlying medical condition based upon advice from ATAGI [3] and the Australian Government Department of Health [7]

• Organ transplant recipients who are on immune suppressive therapy

• Those who have had a bone marrow transplant in the last 24 months

• Those on immune suppressive therapy for graft versus host disease

• Those who have haematological cancers, for example, leukaemia, lymphoma or myelodysplastic syndrome (diagnosed within the last 5 years)

• Those having chemotherapy or radiotherapy

• Those with chronic renal (kidney) failure

• Those with heart disease (including coronary heart disease and cardiac failure)

• Those with chronic lung disease (excludes mild or moderate asthma)

• Those who have a non-haematological cancer (diagnosed in the last 12 months)

• Those who have diabetes

• Severe obesity with a BMI ≥ 40kg/m2

• Those with chronic liver disease

• Those with some neurological conditions (stroke, dementia, other)

• Those with some chronic inflammatory conditions and treatments

• Those with other primary or acquired immunodeficiency (this includes HIV infection)

• Those with poorly controlled blood pressure

For those patients who will attend a vaccination site and may not have a referral letter or other evidence of their 1b eligibility status (e.g. My Health Record, medical history etc) and may often be Medicare Ineligible please use this statutory declaration form: https://www.health.gov.au/resources/publications/covid-19-vaccination-eligibility-declaration-form

• Clinicians who are not accredited to offer COVID-19 vaccines will have to refer their patients to an accredited general practice, or to a purpose-built COVID-19 vaccine clinic

• Some patients will be comfortable for their referral letter to state that they are HIV-positive. In this setting, if the patient is taking cART we would recommend that you state that the patient is HIV-positive and on treatment

• Some patients will not be comfortable for their referral letter to state that they are HIV-positive. In this setting, if a patient has any underlying medical condition/s listed above, the clinician can cite the underlying medical condition/s as the indication/s for COVID-19 vaccination

• However if the patient’s only underlying medical condition is HIV infection and they do not wish for their HIV status to be disclosed, you can state the following in your referral letter
     o That your patient qualifies as a younger adult with an underlying medical condition as per guidance from ATAGI and the Australian Government Department of Health

     o That the patient is on treatment for their underlying medical condition (if they are on cART)

     o That you have discussed with the patient any benefits and the effectiveness of the COVID-19 vaccine in relation to the patient’s underlying medical condition

• Once the patient does attend the new clinic, if they are asked about the specifics of their underlying medical condition that makes them eligible for the COVID-19 vaccine, they should state that they are not comfortable discussing this and if the clinician has any concerns about their eligibility for the vaccine, to contact the doctor who referred them

• Clinicians may also wish to inform patients that their My Health record may be accessed for the purpose of identifying eligibility for the vaccine. Although the access, use and disclosure of this information are still bound by rules of confidentiality the information may include the person’s HIV status depending on their control settings. This may be something patients want to discuss with their clinician or seek advice from a relevant HIV support service if they wish to change these settings or what information can be accessed ahead of attending for vaccination under Phase 1

• No, specific data about vaccine hesitancy in PLWHIV in Australia are not yet available

• A national survey of PLWHIV and PrEP users in Australia, VAX-PLORE, will commence in March 2021 to evaluate COVID-19 vaccine hesitancy

• Both the Pfizer-BioNTech and the AstraZeneca vaccines are highly effective in preventing severe COVID-19 disease in individuals [8-9]. See notes above

• No

• Yes

• Pfizer reportedly enrolled 120 PLWHIV [10]
• AstraZeneca reportedly enrolled 160 PLWHIV [11]

• AstraZeneca’s inclusion criteria for HIV positive people were [12]

     o Receiving antiretroviral therapy
     o Undetectable HIV viral load
     o CD4 cells > 350 cells/mL

• Pfizer reported that they would enrol HIV positive people who had ‘stable HIV infection’ [13]

• No data are available about how well these vaccines protect HIV positive people against COVID-19 disease, but data are expected soon

• The number of people enrolled in these two vaccine studies was small (Pfizer, n=120 and AstraZeneca, n=160) [10-11] Data from these studies are expected to be available soon

• It is anticipated that both these vaccines will be safe in PLWHIV, including those who are not on cART, because they do not contain live SARS-CoV-2 virus
• The Pfizer-BioNTech vaccine contains messenger RNA from the SARS-CoV-2 virus. The AstraZeneca vaccine contains a replication-defective chimpanzee adenovirus, which serves as a vector for the SARS-CoV-2 spike glycoprotein [9]

• It is likely to be safe in PLWHIV

• Clinicians should broadly explain that there are very limited data currently available on the safety and efficacy of the Pfizer-BioNTech and the AstraZeneca COVID-19 vaccines in PLWHIV, but that data will be available in the near future

• All Australians, including PLWHIV, need to be advised that they have to take ongoing protective measures against SARS-CoV-2 infection because COVID-19 vaccines were designed to prevent COVID-19 disease, not to prevent SARS-CoV-2 infection or transmission. Further data are expected about these vaccines’ ability to prevent SARS-CoV-2 infection and transmission

• In the setting where there is minimal, or no background community transmission of SARS-CoV-2 we recommend advising untreated HIV-positive patients to first commence combination antiretroviral therapy (cART) and then have their COVID-19 vaccine once they have become virologically suppressed, which should only take 4-8 weeks. This strategy should improve their chance of having a good immunological response to the vaccine

• In the setting where there is rising, or persistent community transmission of SARS-CoV-2, we recommend advising untreated HIV-positive patients to simultaneously receive a COVID-19 vaccine and commence cART. In this setting, the immunological response to the vaccine may be diminished

• If an HIV-positive person declines cART and requests a COVID-19 vaccine they should be counselled that their immune response to the vaccine is likely to be diminished

• Yes

• Please note that although ATAGI recommends that a person who has had PCR-confirmed SARS-CoV-2 infection may defer their COVID-19 vaccine for six months from the time of infection (3), clinicians should not delay offering COVID-19 vaccines to their HIV-positive patients with prior SARS-CoV-2 infection

      o This is because the immune response to COVID-19 vaccines in PLWHIV is unknown

• There have not been any safety concerns for people who have had prior SARS-CoV-2 infection and go on to receive the Pfizer-BioNTech vaccine, but data are not yet available about this regarding the AstraZeneca vaccine

• The advice that ATAGI provides regarding offering these two vaccines to pregnant HIV-negative people should be applied to pregnant HIV-positive people. The advice is as follows [3]
     o Neither vaccine is routinely recommended in pregnancy, nor are they contraindicated in pregnancy
     o There are no clinical trial data on the safety of either vaccine in pregnancy or in pregnancy outcomes
     o People who are pregnant may choose to accept either of these COVID-19 vaccines if their risk of SARS-CoV-2 infection is high, or if  their underlying medical conditions put them at high risk of severe COVID-19 disease

• There are no data available about the safety of either vaccine in HIV-positive people who are pregnant and ATAGI has not provided specific advice for HIV-positive people who are pregnant

• The advice that ATAGI provides regarding offering these two vaccines to HIV-negative people who are planning pregnancy, or who are breastfeeding should be applied to HIV-positive people who are planning pregnancy, or who are breastfeeding. The advice is as follows [3]:

     o People who are breastfeeding or who are planning pregnancy can receive COVID-19 vaccines. There are no theoretical concerns regarding the safety of Comirnaty or COVID-19 Vaccine AstraZeneca in these groups

• No

• ATAGI does not recommend testing for anti-spike antibodies or neutralising antibodies against SARS-CoV-2 following COVID-19 vaccines [3]. This is because there is currently no recognised immune correlate of protection against infection with SARS-CoV-2 or COVID-19 disease [3]

• There is no evidence or theoretical concerns that either of these vaccines will make HIV antiretrovirals less effective or that HIV antiretrovirals will make either of these vaccines less effective

• ATAGI recommends that the minimal interval between either the COVID-19 vaccine and the annual influenza vaccine and all other vaccines should be 14 days [3]
• This advice is appropriate for PLWHIV

• Two previous HIV vaccine studies, the Step and the Phambili studies used the human adenovirus type 5 (Ad5) as the vaccine vector, as recently summarised by Buchbinder et al (13). These two studies observed an increased risk of HIV infection in male study participants who were Ad5 seropositive, were uncircumcised and who practiced insertive anal or vaginal sex [14]

• However, the AstraZeneca vaccine does not use the Ad5 vector that was used in these HIV vaccine trials; instead it uses a chimpanzee adenovirus to which humans are highly unlikely to have been exposed

• All people who are at risk of HIV acquisition should be encouraged to use appropriate HIV prevention strategies including HIV pre- and post-exposure prophylaxis [15-16] condoms and the U=U strategy, which relies on the science that shows that the risk of HIV transmission is effectively zero from an HIV positive person whose HIV viral load is durably suppressed on cART

• Yes

• Pfizer has enrolled 2,259 children aged 12-15 years into a study[17]. In March 2021 Pfizer commenced a study of children aged 6 months -11 years [18]

• Moderna has commenced a study which will vaccinate 3,000 12-17 year old children

• AstraZeneca and Johnson & Johnson plan to commence studies in adolescents [19]

1. TGA provisionally approves Pfizer COVID-19 vaccine. [Internet] 25 January 2021 https://www.tga.gov.au/media-release/tga-provisionally-approves-pfizer-covid-19-vaccine

2. TGA provisionally approves AstraZeneca's COVID-19 vaccine. [Internet] 16 February 2021 https://www.tga.gov.au/media-release/tga-provisionally-approves-astrazenecas-covid-19-vaccine

3. Australian Government Department of Health, COVID-19 vaccination – ATAGI clinical guidance on COVID-19 Vaccine in Australia in 2021 (v2.0). 24 February 2021 https://www.health.gov.au/resources/publications/covid-19-vaccination-atagi-clinical-guidance-on-covid-19-vaccine-in-australia-in-2021

4. WHO Coronavirus disease (COVID-19): COVID-19 vaccines and people living with HIV [Internet] https://www.who.int/news-room/q-a-detail/coronavirus-disease-(covid-19)-covid-19-vaccines-and-people-living-with-hiv

5. ASHM Taskforce, Statement from the ASHM COVID-19 Taskforce regarding the Prioritisation of COVID-19 Vaccines for People Living with HIV. 18 February 2021 https://ashm.org.au/covid-19/clinical-care/statement-regarding-the-prioritisation-of-covid-19-vaccines/

6. Australian Government Department of Health, COVID-19 vaccination – Australia's COVID-19 vaccine national roll-out strategy. https://www.health.gov.au/resources/publications/covid-19-vaccination-australias-covid-19-vaccine-national-roll-out-strategy

7. Australian Government Department of Health, Advice for people at risk of coronavirus (COVID-19). https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/advice-for-people-at-risk-of-coronavirus-covid-19

8. Polack FP, Thomas SJ, Kitchin N et al, Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine December 31, 2020, N Engl J Med 2020; 383:2603-2615 DOI: 10.1056/NEJMoa2034577 https://www.nejm.org/doi/full/10.1056/NEJMoa2034577

9. Voysey M, Costa Clemens SA, Madhi SA et al, Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. The Lancet Volume 397, Issue 10269, P99-111, January09, 2021 Published: December 08, 2020DOI:https://doi.org/10.1016/S0140-6736(20)32661-1 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32661-1/fulltext

10. Australian Technical Advisory Group on Immunisation (ATAGI, Clinical guidance on use of COVID-19 vaccine in Australia in 2021.Version 1.0 5 February 2021 https://www.health.gov.au/sites/default/files/documents/2021/02/covid-19-vaccination-atagi-clinical-guidance-on-covid-19-vaccine-in-australia-in-2021.pdf

11. nam aidsmap, Roger Peabody Have COVID-19 vaccines been tested in people with HIV? February 2021 [Internet] https://www.aidsmap.com/about-hiv/have-covid-19-vaccines-been-tested-people-hiv

12. U.S. National Library of Medicine, Investigating a Vaccine Against COVID-19 Internet https://clinicaltrials.gov/ct2/show/NCT04400838

13. Therapeutic Goods Administration, Australian Product Information – COMIRNATY™ (BNT162b2 [mRNA]) COVID-19 Vaccine https://www.tga.gov.au/sites/default/files/auspar-bnt162b2-mrna-210125-pi.pdf

14. Buchbinder SP, McElrath MJ, Dieffenbach et al , Use of adenovirus type-5 vectored vaccines: a cautionary tale. The Lancet Volume 396 Issue 10260 E68-E69, October 31 2020 Published:October 19, 2020DOI:https://doi.org/10.1016/S0140-6736(20)32156-5 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32156-5/fulltext

15. ASHM, The ASHM PrEP Guidelines Sept 2019 Update https://ashm.org.au/resources/hiv-resources-list/prep-guidelines-2019/

16. ASHM, Post-Exposure Prophylaxis (PEP) Published August 2016 https://www.ashm.org.au/HIV/hiv-management/PEP/

17. Pfizer, Pfizer-Biontech COVID-19 Vaccine Trial Overview, [Internet] https://www.pfizer.com/science/coronavirus/vaccine

18. Pfizer, Pfizer Studies in Additional Populations, [Internet] https://www.pfizer.com/science/coronavirus/vaccine/additional-population-studies

19. Medscape Medical News, Marill MC published February 04 2021 [Internet] https://www.medscape.com/viewarticle/945331

* This document was written by the ASHM COVID-19 Taskforce Chair and was reviewed by the ASHM Taskforce Co-Chair, members of the Virology, HIV, Research & Understanding the Data Cluster Taskforce Group Members and the ASHM CEO.

ASHM COVID-19 Taskforce Chair: A/Prof Edwina Wright
ASHM COVID-19 Taskforce Co-Chair: Mr Scott McGill
Members of the Virology, HIV, Research & Understanding the Data, Pharmacy, Practice Management and Nursing Clusters


Martyn French 
Sharon Lewin 
Thomas Rasmussen 


Adam Ehm 
Alison Cowell 
Belinda Wozencroft 
Brian Price 
Charles Gilks 
Darren Russell 
Darryl O’Donnell 
Dean Murphy 
Edwina Wright 
Jenny Hoy  
Joan Ingram (NZ) 
John Rule 
Kathy Petoumenous 
Lauren Foy 
Mark Bloch 
Megan McAnally 
Nick Medland 
Olga Vujovic 
Tiffany Tran 

Research and Understanding the Data

Carla Treloar 
Charles Gilks 
Gail Matthews 
Graham Brown 
Jack Wallace 
James McMahon 
John Rule 
Julian Elliott
Lisa Maher 


Ms Alison Duncan
Mr Bruce Hamish Bowden
Ms Claire Bekema
Mr Vihung Kapadia

Practice Management

Dr David Baker
Dr Elizabeth Crock
Ms Penny Kenchington
Dr Nick Medland
Sally Watkinson
Donna Tilley
Leanne Myers


Dr Jacqui Richmond
Ms Jana Van der Jagt
Ms Marrianne Black
Shannon Woodward
Bradley Whitton
Melissa Cromarty
Gabrielle Bennett

ASHM Staff Members who are members of these Cluster Groups
Scott McGill, Karen Seager, Bianca Leber, Kate Bath

ASHM CEO, Alexis Apostolellis


Disclaimer: This ASHM document is designed to provide available, relevant information to clinicians and other healthcare providers to optimise the health and wellbeing of people living with HIV (PLWHIV) during the COVID-19 pandemic. The recommendations provided are the opinions of the authors and are not intended to provide a standard of care, or practice. This document does not reflect a systematic review of the evidence, but will be revised to include relevant future systematic review findings of the National COVID-19 Clinical Evidence Taskforce(1) and other relevant information.