Covid-19 vaccine immunogenicity in people living with HIV-1

Abstract

Introduction: COVID-19 vaccine efficacy has been evaluated in large clinical trials and in real-world situation. Although they have proven to be very effective in the general population, little is known about their efficacy in immunocompromised patients. HIV-infected individuals' response to vaccine may vary according to the type of vaccine and their level of immunosuppression. We evaluated immunogenicity of an mRNA anti-SARS CoV-2 vaccine in HIV-positive individuals.

Methods: HIV-positive individuals (n = 121) were recruited from HIV clinics in Montreal and stratified according to their CD4 counts. A control group of 20 health care workers naïve to SARS CoV-2 was used. The participants' Anti-RBD IgG responses were measured by ELISA at baseline and 3-4 weeks after receiving the first dose of an mRNA vaccine).

Results: Eleven of 121 participants had anti-COVID-19 antibodies at baseline, and a further 4 had incomplete data for the analysis. Mean anti-RBD IgG responses were similar between the HIV negative control group (n = 20) and the combined HIV+ group (n = 106) (p = 0.72). However, these responses were significantly lower in the group with <250 CD4 cells/mm³. (p < 0.0001). Increasing age was independently associated with decreased immunogenicity.

Conclusion: HIV-positive individuals with CD4 counts over 250 cells/mm³ have an anti-RBD IgG response similar to the general population. However, HIV-positive individuals with the lowest CD4 counts (<250 cells/mm³) have a weaker response. These data would support the hypothesis that a booster dose might be needed in this subgroup of HIV-positive individuals, depending on their response to the second dose.

Keywords: Covid-19 Vaccine immunogenicity; Covid-19 Vaccines in Immunocompromised Patients; Covid-19 Vaccines in people living with HIV; Vaccine immunogenicity HIV; mRNA Vaccines in people living with HIV; mRNA vaccine immunogenicity in people living with HIV.

Fig. 1

Immunogenicity in each study group. Immunogenicity (anti-RBD IgG response) was measured by ELISA and reported in RLU (relative luminescence units) normalized to CR3022. RLU values log transformed for analysis. Statistically significant mean differences are denoted by * (Tukey-Kramer test, p < 0.001).

Fig. 2

As part of the regression model, immunogenicity was found to be statistically significantly correlated with age (p < 0.001). The magnitude of the association is weak, with an increase in 10 years corresponding to a decrease in 0.29 log(RLU). The range of RLU normalized to CR3022 in this population was 2.56 (detection limit) to 236.03 (0.94 to 5.46 in log(RLU)).