Humoral SARS-CoV-2 vaccine responses are durable in solid organ transplant recipients with and without HIV

Abstract

Background: Solid organ transplant (SOT) recipients may have a suboptimal humoral immune response to the coronavirus disease 2019 (COVID-19) vaccine, prompting the need for additional doses of vaccine for immunocompromised patients. However, data on vaccine immunogenicity in SOT recipients with well controlled HIV infection remain scarce. We aimed to assess the effect of well controlled HIV infection on vaccine responses in SOT recipients, as compared to those without HIV.

Methods: We conducted a prospective observational cohort single-center study of SOT recipients with and without HIV-1 infection who had received two doses of mRNA COVID-19 vaccine and were planning to receive additional doses. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binding and neutralizing antibody responses were measured at several time points after vaccination.

Findings: SOT recipients with HIV (44/122, 36 %) and without HIV infection (78/122, 64 %) showed comparable binding and neutralizing SARS-CoV-2 antibody titers at baseline as well as over time. Overall, 65 % of all SOT recipients were seropositive prior to a third vaccine dose. Twenty-seven participants were seronegative at baseline; three (11 %) were participants with HIV. Additional vaccine doses and SARS-CoV-2 infections led to seroconversion in most participants (21/27). None of those who remained seronegative (N: 6) had HIV but all received antimetabolites.

Interpretation: Well-controlled HIV infection did not significantly affect humoral vaccine responses in SOT recipients. These findings support current vaccination strategies in SOT recipients with HIV and underscore the influence of immunosuppressive regimens as well as vaccination timing on COVID-19 vaccine-induced immunity.

Keywords: COVID-19 vaccine; HIV; Humoral immune responses; SARS-CoV-2; Solid organ transplant.