Analysis of Postvaccination Breakthrough COVID-19 Infections among Adults with HIV in the United States

Importance: Recommendations for additional doses of COVID-19 vaccines for people with HIV (PWH) are restricted to those with advanced disease or unsuppressed HIV viral load. Understanding SARS-CoV-2 infection risk after vaccination among PWH is essential for informing vaccination guidelines. Objective: To estimate the rate and risk of breakthrough infections among fully vaccinated PWH and people without HIV (PWoH) in the United States. Design, Setting, and Participants: This cohort study used the Corona-Infectious-Virus Epidemiology Team (CIVET)-II (of the North American AIDS Cohort Collaboration on Research and Design [NA-ACCORD], which is part of the International Epidemiology Databases to Evaluate AIDS [IeDEA]), collaboration of 4 prospective, electronic health record-based cohorts from integrated health systems and academic health centers. Adult PWH who were fully vaccinated prior to June 30, 2021, were matched with PWoH on date of full vaccination, age, race and ethnicity, and sex and followed up through December 31, 2021. Exposures: HIV infection. Main Outcomes and Measures: COVID-19 breakthrough infections, defined as laboratory evidence of SARS-CoV-2 infection or COVID-19 diagnosis after a patient was fully vaccinated. Results: Among 113994 patients (33029 PWH and 80965 PWoH), most were 55 years or older (80017 [70%]) and male (104967 [92%]); 47098 (41%) were non-Hispanic Black, and 43218 (38%) were non-Hispanic White. The rate of breakthrough infections was higher in PWH vs PWoH (55 [95% CI, 52-58] cases per 1000 person-years vs 43 [95% CI, 42-45] cases per 1000 person-years). Cumulative incidence of breakthroughs 9 months after full vaccination was low (3.8% [95% CI, 3.7%-3.9%]), albeit higher in PWH vs PWoH (4.4% vs 3.5%; log-rank P <.001; risk difference, 0.9% [95% CI, 0.6%-1.2%]) and within each vaccine type. Breakthrough infection risk was 28% higher in PWH vs PWoH (adjusted hazard ratio, 1.28 [95% CI, 1.19-1.37]). Among PWH, younger age (<45 y vs 45-54 y), history of COVID-19, and not receiving an additional dose (aHR, 0.71 [95% CI, 0.58-0.88]) were associated with increased risk of breakthrough infections. There was no association of breakthrough with HIV viral load suppression, but high CD4 count (ie, ≥500 cells/mm3) was associated with fewer breakthroughs among PWH. Conclusions and Relevance: In this study, COVID-19 vaccination, especially with an additional dose, was effective against infection with SARS-CoV-2 strains circulating through December 31, 2021. PWH had an increased risk of breakthrough infections compared with PWoH. Expansion of recommendations for additional vaccine doses to all PWH should be considered.

Analysis of Severe Illness after Postvaccination COVID-19 Breakthrough among Adults with and Without HIV in the US

Importance: Understanding the severity of postvaccination SARS-CoV-2 (ie, COVID-19) breakthrough illness among people with HIV (PWH) can inform vaccine guidelines and risk-reduction recommendations. Objective: To estimate the rate and risk of severe breakthrough illness among vaccinated PWH and people without HIV (PWoH) who experience a breakthrough infection. Design, Setting, and Participants: In this cohort study, the Corona-Infectious-Virus Epidemiology Team (CIVET-II) collaboration included adults (aged ≥18 years) with HIV who were receiving care and were fully vaccinated by June 30, 2021, along with PWoH matched according to date fully vaccinated, age group, race, ethnicity, and sex from 4 US integrated health systems and academic centers. Those with postvaccination COVID-19 breakthrough before December 31, 2021, were eligible. Exposures: HIV infection. Main Outcomes and Measures: The main outcome was severe COVID-19 breakthrough illness, defined as hospitalization within 28 days after a breakthrough SARS-CoV-2 infection with a primary or secondary COVID-19 discharge diagnosis. Discrete time proportional hazards models estimated adjusted hazard ratios (aHRs) and 95% CIs of severe breakthrough illness within 28 days of breakthrough COVID-19 by HIV status adjusting for demographic variables, COVID-19 vaccine type, and clinical factors. The proportion of patients who received mechanical ventilation or died was compared by HIV status. Results: Among 3649 patients with breakthrough COVID-19 (1241 PWH and 2408 PWoH), most were aged 55 years or older (2182 patients [59.8%]) and male (3244 patients [88.9%]). The cumulative incidence of severe illness in the first 28 days was low and comparable between PWoH and PWH (7.3% vs 6.7%; risk difference, -0.67%; 95% CI, -2.58% to 1.23%). The risk of severe breakthrough illness was 59% higher in PWH with CD4 cell counts less than 350 cells/μL compared with PWoH (aHR, 1.59; 95% CI, 0.99 to 2.46; P =.049). In multivariable analyses among PWH, being female, older, having a cancer diagnosis, and lower CD4 cell count were associated with increased risk of severe breakthrough illness, whereas previous COVID-19 was associated with reduced risk. Among 249 hospitalized patients, 24 (9.6%) were mechanically ventilated and 20 (8.0%) died, with no difference by HIV status. Conclusions and Relevance: In this cohort study, the risk of severe COVID-19 breakthrough illness within 28 days of a breakthrough infection was low among vaccinated PWH and PWoH. PWH with moderate or severe immune suppression had a higher risk of severe breakthrough infection and should be included in groups prioritized for additional vaccine doses and risk-reduction strategies

Self-report outcome in new hearing-aid users: Longitudinal trends and relationships between subjective measures of benefit and satisfaction

This study focussed on self-report outcome in new hearing-aid users. The objectives of the experiment were changes in self-report outcome over time, and relationships between different subjective measures of benefit and satisfaction. Four outcome inventories and a questionnaire on auditory lifestyle were administered to 25 hearing-aid users repeatedly after hearing-aid fitting, and assessments took place one week, four weeks, and 13 weeks after hearing-aid provision. The results showed that, for first-time users who used their hearing aids more than four hours per day, self-reported outcome increased over 13 weeks in some scales, although there was no change in amplification during this time. Furthermore, it was found that, for data collected immediately post-fitting, some subscales were much less face valid than for data collected later. This result indicates that the way in which hearing-aid users assess outcome changes over time. The practical consequence of the results is that early self-report outcome assessment may be misleading for some self-report outcome schemes

Survey on hearing aid use and satisfaction in Switzerland and their determinants

The purpose of this study was to investigate the efficiency of the Swiss hearing aid dispensing system, and to determine factors contributing to successful hearing aid provision. A national cross sectional survey was performed using a postal questionnaire with 8707 adult hearing aid owners (response rate 62%). To correct results for a potential non-response bias, 193 randomly selected non-respondents were contacted by telephone. Data on hearing loss and type of hearing aid were provided by the hearing aid dispensing practice. Logistic regression analyses were performed to identify determinants of non-regular use and dissatisfaction. Eighty-five percent used their device(s) regularly, 12% only occasionally and 3% never. Eighty percent were satisfied with their aids. Non-regular use of hearing aids was significantly associated with age, gender, regional language, total duration of use, type of amplification, hearing aid category, hearing loss, and dissatisfaction with and difficulties in managing the aid. Dissatisfaction was associated with regional language, total duration of use, difficulties in managing the aid, and non-regular use. It was concluded that rates of regular hearing aid use and satisfaction are high in Switzerland