The scientists here examined associations of substance use and HIV status and severity with breakthrough infections, using Cox proportional hazards regression hazard ratios. AUD and other SUD were associated with increased risk of breakthrough, and this was similar by HIV status. Compared to PWoH, PWH at all HIV severity levels had increased risk of breakthrough ranging from 9% for PWH with CD4 count 500 cells/ l to 59% for PWH with CD4 count < 200. HIV was associated with breakthrough; risk was greatest among PWH with lower CD4 count. In addition to inhibiting HIV treatment adherence and increasing HIV progression, AUD and other SUD may increase COVID-19 breakthrough risk.
