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MASHM POSITIONAL STATEMENT ON COVID-19 VACCINATION FOR PEOPLE LIVING WITH HIV (PLHIV)

People living with HIV (PLHIV) may experience similar risks for acquiring COVID-19 infection compared to the general population. However, it is uncertain if PLHIV with COVID-19 will have a poorer outcome. Coexisting medical health issues including diabetes mellitus, ischemic heart disease and chronic renal disease will increase the risks of adverse outcome with COVID -19.

The current COVID-19 vaccines in “Phase 3 Studies” fall into 4 main categories:

  • mRNA vaccines: e.g. Pfizer-BioNTech, Moderna, Arcturus

  • Virus vectored vaccines: e.g. Astra-Zeneca, Gamaleya, Can-Sino

  • Inactivated virus vaccines: e.g. Sinovac, Bharat

  • Protein subunit vaccines: e.g. Novavax, Sanofi-Pasteur

None of these are live virus vaccine, hence they are safe in people with immune compromising diseases, including PLHIV irrespective of their CD4 count and HIV viral load.

There are some concerns about reduced vaccine efficacy in PLHIV. The data is unclear but the vaccine is expected to be protective for PLHIV as well.


The adverse effects post vaccination are generally mild and manageable and should resolve in a few days.

A small number of vaccine recipients may develop severe allergic reactions post immunization and vaccine recipients should be observed for 15 – 30 minutes after the injection. There is no data to support that PLHIV will experience more adverse reactions compare to the general population. Anyone with a history of anaphylactic shock should not receive the mRNA vaccine regardless of their HIV status.

These recommendations are based on expert consensus. They may change when more scientific evidence becomes available.

SHOULD PLHIV BE OFFERED COVID -19 VACCINE ?

  • PLHIV should be offered the COVID -19 vaccine. Like those who are in older age groups and those with other medical illnesses they should be prioritised for vaccination.

  • Covid –19 vaccine offers the same benefit to PLHIV against severe COVID 19 disease and could potentially reduce transmission.

  • PLHIV need to continue practicing preventive measures against SARS CoV 2 virus even after vaccination.

  • PLHIV need to continue taking anti retroviral therapy before and after the COVID-19 vaccine.

KENYATAAN POSISI MASHM TERHADAP VAKSINASI COVID-19 UNTUK ORANG YANG HIDUP DENGAN HIV (PLHIV)


Orang yang hidup dengan HIV (PLHIV) mungkin mengalami risiko serupa untuk mendapat jangkitan COVID-19 berbanding dengan populasi umum. Namun, ia tidak dapat dipastikan jika PLHIV dengan COVID-19 akan memberikan kesan yang lebih buruk. Masalah kesihatan perubatan yang sedia ada termasuk penyakit kencing manis, penyakit jantung dan penyakit buah pinggang kronik akan meningkatkan risiko terhadap COVID -19.


Vaksin COVID-19 semasa, berada dalam "Kajian Fasa 3" termasuk dalam 4 kategori utama:

  • Vaksin mRNA: mis. Pfizer-BioNTech, Moderna, Arcturus

  • Vaksin vektor virus: mis. Astra-Zeneca, Gamaleya, Can-Sino

  • Vaksin virus yang tidak aktif: mis. Sinovac, Bharat

  • Vaksin subunit protein: mis. Novavax, Sanofi-Pasteur

Tidak satu pun dari mereka adalah vaksin virus yang hidup, oleh itu ia selamat kepada orang yang berpenyakit yang membahayakan imun; termasuklah PLHIV; tanpa mengira jumlah CD4 dan timbunan virus (viral load) HIV mereka.


Terdapat beberapa kebimbangan mengenai keberkesanan vaksin terhadap PLHIV. Data sedia ada masih belum jelas tetapi vaksin ini juga diharapkan dapat melindungi bagi PLHIV daripada COVID-19.


Kesan sampingan selepas vaksinasi COVID-19 umumnya, ringan dan dapat diatasi dan akan hilang dalam beberapa hari.


Sebilangan kecil penerima vaksin boleh mengalami reaksi alergi yang teruk selepas imunisasi dan penerima vaksin akan berada dalam pemerhatian selama 15 - 30 minit selepas suntikan. Tidak ada data yang menyokong bahawa PLHIV akan mengalami lebih banyak kesan sampingan berbanding dengan populasi umum. Sesiapa yang mempunyai sejarah kejutan anafilaksis tidak boleh menerima vaksin mRNA tanpa mengira status HIV mereka.


Cadangan ini berdasarkan kata sepakat daripada pakar-pakar. Ia mungkin berubah apabila mendapat lebih banyak lagi bukti saintifik.


ADAKAH PLHIV PERLU DIBERIKAN VAKSIN COVID -19?

- Pesakit HIV perlu ditawarkan vaksin COVID-19 sebagaimana kumpulan keutamaan berisiko lain (seperti warga emas, pesakit dengan penyakit perubatan kronik dan lain-lain)

- Vaksin COVID-19 bermanfaat untuk melindungi pesakit HIV dari komplikasi jangkitan COVID-19 dan berpotensi mengurangkan penularan jangkitan.

- Pesakit HIV perlu meneruskan langkah2 pencegahan dari jangkitan COVID-19 walaupun setelah mendapat vaksin.

- Pesakit HIV perlu terus mengambil rawatan antiretroviral sebelum dan selepas mendapat vaksin COVID-19


Dr Chow Ting Soo, Assoc Prof Dr Sharifah Faridah Syed Omar, Dr Khairil Erwan Khalid, Dr Leong Kar Nim, Dr Yasmin Mohamed Gani, Dato Dr Suresh Kumar, Dato Dr Mahiran Mustafa, Dr Sheela Bai Pannir Selvam, Dr Andrew Yap Hoong Yee, Dr Eunice Tiew Wah Tin, Dr Ng Rong Xiang, Dr Tan Kok Tong

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