Unit of Infectious Diseases and Microbiology, Hospital Universitario Virgen de Valme, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain.
Unit of Infectious Diseases and Microbiology, Hospital Universitario Virgen de Valme, Sevilla, Spain.
Clin Microbiol Infect. 2022 Nov;28(11):1492-1498. doi: 10.1016/j.cmi.2022.05.018. Epub 2022 May 28.
The aim of this study was to assess the immunogenicity of SARS-CoV-2 available vaccines among people living with HIV (PLWH) after a complete vaccination scheme, and determine predictors of seroconversion.
This multicentre prospective cohort study included 420 PLWH who had received a standard immunization, either with mRNA or adenoviral-vectored COVID-19 vaccines. Antibody response was evaluated within 1 to 2 months after the last dose of the vaccine with a quantitative determination of antitrimeric spike protein-specific IgG antibodies and IgG neutralizing antibodies.
Overall, 384 of 420 PLWH (91%) showed antibody response to vaccination. Seroconversion was observed in 308 of 326 individuals with cluster of differentiation 4 (CD4) counts ≥350 cells/mm (95%), 55 of 61 PLWH with 200 to 349 cells/mm (90%), and 21 of 33 PLWH with CD4 counts <200 cells/mm (64%; p < 0.001). The median log IgG neutralization levels were 2.4 IU/mL (Q1-Q3, 1.0-3.1) among PLWH with CD4 counts <200 cells/mm, 3.1 IU/mL (Q1-Q3, 2.8-3.4) for the 200 to 349 cells/mm group, and 3.1 IU/mL (Q1-Q3, 2.7-3.4) for PLWH with CD4 counts ≥350 cells/mm (p = 0.016). In the multivariate analysis, CD4 counts ≥350 cells/mm (OR: 7.10; 95% CI, 1.91-26.46; p = 0.004) and receiving mRNA-vectored COVID-19 vaccines (OR: 8.19; 95% CI, 3.24-20.70; p ≤ 0.001) were independently associated with a higher probability of response to vaccination.
HIV-related immunosuppression impairs the antibody response to SARS-CoV-2 vaccines. Specific vaccination schemes should be urgently tailored in this setting, particularly in patients with CD4 cell counts <200 cells/μL. Adenoviral-vectored vaccines should be avoided in PLWH whenever possible.
本研究旨在评估完全接种 SARS-CoV-2 疫苗方案后 HIV 感染者（PLWH）对现有疫苗的免疫原性，并确定血清转化的预测因素。
这项多中心前瞻性队列研究纳入了 420 名接受标准免疫接种的 PLWH，接种的疫苗包括 mRNA 或腺病毒载体 COVID-19 疫苗。在最后一剂疫苗接种后 1 至 2 个月内，通过定量测定三聚体刺突蛋白特异性 IgG 抗体和 IgG 中和抗体来评估抗体反应。
总体而言，420 名 PLWH 中有 384 名（91%）对疫苗接种有抗体反应。在 CD4 计数≥350 个细胞/mm（95%）的 326 名个体中，308 名观察到血清转化率，在 CD4 计数为 200 至 349 个细胞/mm（90%）的 61 名 PLWH 中，55 名观察到血清转化率，在 CD4 计数<200 个细胞/mm（64%）的 33 名 PLWH 中，21 名观察到血清转化率（p<0.001）。CD4 计数<200 个细胞/mm 的 PLWH 的中位 IgG 中和抗体水平为 2.4 IU/mL（Q1-Q3，1.0-3.1），CD4 计数为 200 至 349 个细胞/mm 的 PLWH 为 3.1 IU/mL（Q1-Q3，2.8-3.4），CD4 计数≥350 个细胞/mm 的 PLWH 为 3.1 IU/mL（Q1-Q3，2.7-3.4）（p=0.016）。在多变量分析中，CD4 计数≥350 个细胞/mm（比值比：7.10；95%置信区间，1.91-26.46；p=0.004）和接种 mRNA 载体 COVID-19 疫苗（比值比：8.19；95%置信区间，3.24-20.70；p≤0.001）与接种疫苗后的更高反应概率独立相关。
HIV 相关免疫抑制会损害对 SARS-CoV-2 疫苗的抗体反应。在此背景下，应紧急制定特定的疫苗接种方案，特别是在 CD4 细胞计数<200 个细胞/μL 的患者中。应尽可能避免在 PLWH 中使用腺病毒载体疫苗。
