COVID-19 Vaccines for HIV-Infected Patients

Abstract

Nearly 40 years have passed since the initial cases of infection with the human mmunodeficiency virus (HIV) were identified as a new disease entity and the cause of acquired immunodeficiency disease (AIDS). This virus, unlike any other, is capable of causing severe suppression of our adaptive immune defense mechanisms by directly infecting and destroying helper T cells leading to increased susceptibility to a wide variety of microbial pathogens, especially those considered to be intracellular or opportunistic. After T cells are infected, HIV reproduces itself via a somewhat unique mechanism involving various metabolic steps, which includes the use of a reverse transcriptase enzyme that enables the viral RNA to produce copies of its complementary DNA. Subsequent physiologic steps lead to the production of new virus progeny and the eventual death of the invaded T cell. Fortunately, both serologic and molecular tests (such as PCR) can be used to confirm the diagnosis of an HIV infection. In the wake of the current COVID-19 pandemic, it appears that people living with HIV/AIDS are equally or slightly more susceptible to the etiologic agent, SARS-CoV-2, than the general population having intact immune systems, but they may have more serious outcomes. Limited clinical trials have also shown that the currently available COVID-19 vaccines are both safe and effective in affording protection to HIV/AIDS patients. In this review, we further explore the unique dynamic of HIV/AIDS in the context of the worldwide COVID-19 pandemic and the implementation of vaccines as a protective measure against COVID-19, as well as what immune parameters and safeguards should be monitored in this immunocompromised group following vaccination.

Keywords: AIDS; COVID-19; HIV; SARS-Cov-2; SARS-Cov-2 vaccines; mRNA.

Figure 1

Timeline of virologic and serologic events associated with HIV infection. The length of time between when exposure to the virus occurs and there is dissemination of HIV is systemically dependent upon the manner in which the virus is acquired. The eclipse period represents the time from the exposure event to the first detectable marker of infection—when HIV RNA appears in the blood. Times to reactivity for each type of diagnostic test are depicted under the graph, from the earliest one—the nucleic acid amplification test (NAT)—to the latest assay system (test for IgG antibodies). A Western blot (or immunoblot) is used to confirm an initial positive result from a standard serologic test such as an ELISA. This latter aspect of the serologic algorithm is to ensure that an initial serologically-derived positive test result is not a false-positive. A Western blot is also not supposed to be used initially as a screening test, irrespective of the patient presentation, primarily for cost-containment purposes. Adapted from Maag, 2021 [7].