Jongkees Marlou J, Bogers Susanne, de Vries Rory D, GeurtsvanKessel Corine H, Miranda Afonso Pedro, Hensley Kathryn S, Rijnders Bart J A, Brinkman Kees, Rokx Casper, Roukens Anna H E
Department of Internal Medicine, Section Infectious Diseases, and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Department of Viroscience, Erasmus University Medical Centre, Rotterdam, The Netherlands.
PLoS One. 2025 May 19;20(5):e0323792. doi: 10.1371/journal.pone.0323792. eCollection 2025.
Although guidelines for COVID-19 additional vaccination strategies generally prioritise people with advanced HIV infection, recommendations vary globally, with some countries recommending an annual vaccination for all people with HIV (PWH), while others restrict this to PWH with a CD4+ T-cell count < 200 cells per µL.
We conducted a prospective cohort study in 448 adult PWH. The primary outcome was the SARS-CoV-2 spike (S1)-specific IgG antibody level at 1, 6, 12, 18, and 24 months after completing a primary COVID-19 vaccination series (two doses of BNT162b2, mRNA-1273, or ChAdOx1-S, or one dose of Ad26.COV2.S). We compared the antibody kinetics over two years between PWH with a baseline CD4+ T-cell count < 200 cells per µL (n = 16) vs. ≥ 200 cells per µL (n = 432) with a mixed-effects model. Secondary outcomes included variables associated with the kinetics of S1-specific antibody levels and the incidence of breakthrough infections.
The median most recent CD4+ T-cell count prior to primary vaccination was 140 (IQR 80-165) in the < 200 cells per µL group, and 688 (IQR 520-899) in the ≥ 200 cells per µL group at the time of primary vaccination. S1-specific antibodies were lower in PWH with a CD4+ T-cell count < 200 vs. ≥ 200 cells per µL during the two-year follow-up, with predicted S1-specific antibody levels of 514 (95% CI 456-578) vs. 2758 (95% CI 1488-5110) BAU per mL at 12 months (p < 0.001) and 839 (95% CI 732-959) vs. 3505 (95% CI 1712-7175) BAU per mL at 24 months (p < 0.001). The overall incidence of SARS-CoV-2 infections was 55% and comparable between groups. A CD4+ T-cell count < 200 cells per µL, higher age, and a vector-based primary vaccination series were negatively associated with S1-specific antibody levels over time.
Long-term humoral responses were lower in PWH with a CD4+ T-cell count < 200 cells per µL compared to those with a CD4+ T-cell count ≥ 200 cells per µL. National COVID-19 vaccine guidelines recommending booster vaccines for all PWH, should therefore specifically emphasise the need for booster vaccines in those with a CD4+ T-cell count < 200 cells per µL. Trial registration: The trial was registered on the International Clinical Trials Platform (registration number: EUCTR2021-001054-57-N).
尽管关于新冠病毒额外疫苗接种策略的指南通常将晚期HIV感染者列为优先接种对象，但全球范围内的建议各不相同，一些国家建议对所有HIV感染者（PWH）每年进行疫苗接种，而其他国家则将此限制在CD4 + T细胞计数低于每微升200个细胞的PWH人群中。
我们对448名成年PWH进行了一项前瞻性队列研究。主要结局是在完成新冠病毒初级疫苗接种系列（两剂BNT162b2、mRNA - 1273或ChAdOx1 - S，或一剂Ad26.COV2.S）后的1、6、12、18和24个月时的新冠病毒刺突（S1）特异性IgG抗体水平。我们使用混合效应模型比较了基线CD4 + T细胞计数低于每微升200个细胞（n = 16）与≥每微升200个细胞（n = 432）的PWH在两年内的抗体动力学。次要结局包括与S1特异性抗体水平动力学相关的变量以及突破性感染的发生率。
初级疫苗接种前，CD4 + T细胞计数低于每微升200个细胞组的最近一次CD4 + T细胞计数中位数为140（四分位间距80 - 165），而≥每微升200个细胞组在初级疫苗接种时为688（四分位间距520 - 899）。在两年的随访期间，CD4 + T细胞计数低于每微升200个细胞的PWH的S1特异性抗体低于≥每微升200个细胞的PWH，12个月时预测的S1特异性抗体水平分别为每毫升514（95%置信区间456 - 578）BAU和每毫升2758（95%置信区间1488 - 5110）BAU（p < 0.001），24个月时分别为每毫升839（95%置信区间732 - 959）BAU和每毫升3505（95%置信区间1712 - 7175）BAU（p < 0.001）。新冠病毒感染的总体发生率为55%，两组之间相当。CD4 + T细胞计数低于每微升200个细胞、年龄较大以及基于载体的初级疫苗接种系列与随时间推移的S1特异性抗体水平呈负相关。
与CD4 + T细胞计数≥每微升200个细胞的PWH相比，CD4 + T细胞计数低于每微升200个细胞的PWH的长期体液反应较低。因此，建议所有PWH接种加强疫苗的国家新冠病毒疫苗指南应特别强调CD4 + T细胞计数低于每微升200个细胞的人群接种加强疫苗的必要性。试验注册：该试验在国际临床试验平台注册（注册号：EUCTR2021 - 001054 - 57 - N）。
