Humoral response to anti-COVID immunization and SARS-CoV-2 infection in HIV-infected persons
Abstract
Background/Aim. At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, human immunodeficiency virus (HIV)-infected persons (HIP) were considered to be at an increased risk of more severe forms of the disease. Although vaccination of HIP is deemed essential, data on the humoral response to both infection and vaccination in this population are inconsistent, particularly when comparing different vaccine types. The aim of this study was to examine factors that could influence severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) anti-spike protein antibody titers in HIP after vaccination and/or exposure to the virus. Methods. The study included all HIP who came for routine check-ups to the Center for HIV/AIDS of the University Clinical Center of Vojvodina, Serbia, from April to December 2022 and who had received at least two doses of the vaccine or had a positive history of COVID-19. Data on age, duration of antiretroviral therapy (ART), nadir and current CD4+ and CD8+ T-cell counts, and type of vaccine were collected from medical records and the national database. Immunoglobulin G (IgG) antibodies against SARS-CoV-2 spike protein were determined in the sera of HIP using the AdviseDx SARS-CoV-2 IgG II assay. Results. The research included 226 HIP with undetectable viremia, in 96.3% of cases, the CD4 T-lymphocyte count was over 350 cells/mm3. Out of 171 HIP who received at least two doses of a vaccine, 64 (37.4%) were both vaccinated and had COVID-19 and 107 (62.6%) were vaccinated and had no evidence of COVID-19. Among the vaccinated participants, 62% received three doses and 38% received two vaccine doses. Regarding the type of vaccine, 59.6% of participants received a messenger ribonucleic acid (mRNA) vaccine, 25.1% an inactivated vaccine, and 15.3% received a vector vaccine. A better humoral response was observed in the mRNA compared to the inactivated vaccines and in three compared to two doses in the case of mRNA vaccines. Age and duration of ART negatively correlated with antibody titers, while the number of CD8 T-cells had a positive correlation. Conclusion. The study showed the immunogenicity and safety of full vaccination against COVID-19 in HIP with any of the available vaccines.
References
Barbera LK, Kamis KF, Rowan SE, Davis AJ, Shehata S, Carlson JJ, et al. HIV and COVID-19: review of clinical course and outcomes. HIV Res Clin Pract 2021; 22(4): 102–18.
Ambrosioni J, Blanco JL, Reyes-Urueña JM, Davies MA, Sued O, Marcos MA, et al. Overview of SARS-CoV-2 infection in adults living with HIV. Lancet HIV 2021; 8(5): e294–305.
Baskaran V, Lawrence H, Lansbury LE, Webb K, Safavi S, Zai-nuddin NI, et al. Co-infection in critically ill patients with COVID-19: an observational cohort study from England. J Med Microbiol 2021; 70(4): 001350.
Del Amo J, Polo R, Moreno S, Jarrín I, Hernán MA. SARS-CoV-2 infection and coronavirus disease 2019 severity in persons with HIV on antiretroviral treatment. AIDS 2022; 36(2): 161–8.
Yang X, Sun J, Patel RC, Zhang J, Guo S, Q Zheng, et al. Associations between HIV infection and clinical spectrum of COVID-19: a population level analysis based on US National COVID Cohort Collaborative (N3C) data. Lancet HIV 2021; 8(11): e690–700.
Bertagnolio S, Thwin SS, Silva R, Nagarajan S, Jassat W, Fowler R, et al. Clinical features of, and risk factors for, severe or fatal COVID-19 among people living with HIV admitted to hospital: analysis of data from the WHO Global Clinical Platform of COVID-19. Lancet HIV 2022; 9(7): e486–95.
Madhi SA, Koen AL, Izu A, Fairlie L, Cutland CL, Baillie V, et al. Safety and immunogenicity of the ChAdOx1 nCoV-19 (AZD1222) vaccine against SARS-CoV-2 in people living with and without HIV in South Africa: an interim analysis of a randomised, double-blind, placebo-controlled, phase 1B/2A trial. Lancet HIV 2021; 8(9): e568–80. Erratum in: Lancet HIV 2022; 9(12): e822.
Ruddy JA, Boyarsky BJ, Bailey JR, Karaba AH, Garonzik-Wang JM, Segev DL, et al. Safety and antibody response to two-dose SARS-CoV-2 messenger RNA vaccination in persons with HIV. AIDS 2021; 35(14): 2399–401.
Maine GN, Krishnan SM, Walewski K, Trueman J, Sykes E, Sun Q. Clinical and analytical evaluation of the Abbott AdviseDx quantitative SARS-CoV-2 IgG assay and comparison with two other serological tests. J Immunol Methods 2022; 503: 113243.
Popovska Jovičić B, Raković I, Pavković A, Marković V, Petrović S, Gavrilović J, et al. Significance of initial clinical laboratory pa-rameters as prognostic factors in patients with COVID 19. Vojnosanit Pregl 2022; 79(9): 849–56.
Gojković Z, Djokanović D, Nikić G, Jović-Djokanović O, Mavija Z, Rakita I, et al. COVID-19 infection in patients with malignant diseases. Vojnosanit Pregl 2020; 77(11): 1235–6.
Brumme ZL, Mwimanzi F, Lapointe HR, Cheung PK, Sang Y, MC Duncan, et al. Humoral immune responses to COVID-19 vaccination in people living with HIV receiving suppressive antiretroviral therapy. NPJ Vaccines 2022; 7(1): 28.
Søndergaard MH, Thavarajah JJ, Churchill Henson H, Wejse CM. SARS‐CoV‐2 vaccine immunogenicity for people living with HIV: a systematic review and meta‐analysis. HIV Med 2024; 25(1): 16–37.
Zhou Q, Liu Y, Zeng F, Meng Y, Liu H, Deng G. Correlation be-tween CD4 T-cell counts and seroconversion among COVID-19 vaccinated patients with HIV: a meta-analysis. Vaccines (Basel) 2023; 11(4): 789.
Kelley CF, Kitchen CM, Hunt PW, Rodriguez B, Hecht FM, Kitahata M, et al. Incomplete peripheral CD4+ cell count restoration in HIV-infected patients receiving long-term antiretroviral treatment. Clin Infect Dis 2009; 48(6): 787–94.
Gazzola L, Tincati C, Bellistré GM, d'Arminio Monforte A, Marchetti G. The absence of CD4+ T cell count recovery despite receipt of virologically suppressive highly active antiretroviral therapy: clinical risk, immunological gaps, and therapeutic options. Clin Infect Dis 2009; 48(3): 328–37.
Harty JT, Tvinnereim AR, White DW. CD8+ T cell effector mechanisms in resistance to infection. Annu Rev Immunol 2000; 18: 275–308.
Schmidt ME, Varga SM. The CD8 T Cell Response to Respira-tory Virus Infections. Front Immunol 2018; 9: 678.
Oberhardt V, Luxenburger H, Kemming J, Schulien I, Ciminski K, Giese S, et al. Rapid and stable mobilization of CD8+ T cells by SARS-CoV-2 mRNA vaccine. Nature 2021; 597(7875): 268–73.
Sahin U, Muik A, Derhovanessian E, Vogler I, Kranz LM, M Vormehr, et al. COVID-19 vaccine BNT162b1 elicits human antibody and TH1 T cell responses. Nature 2020; 586(7830): 594–9. Erratum in: Nature 2021; 590(7844): E17.
Sahin U, Muik A, Vogler I, Derhovanessian E, Kranz LM, Vormehr M, et al. BNT162b2 vaccine induces neutralizing antibodies and poly-specific T cells in humans. Nature 2021; 595(7868): 572–7.
Li C, Lee A, Grigoryan L, Arunachalam PS, Scott MK, M Trisal, et al. Mechanisms of innate and adaptive immunity to the Pfizer-BioNTech BNT162b2 vaccine. Nat Immunol 2022; 23(4): 543–55.
Borriello F, Poli V, Shrock E, Spreafico R, Liu X, Pishesha N, et al. An adjuvant strategy enabled by modulation of the physical properties of microbial ligands expands antigen immunogenicity. Cell 2022; 185(4): 614–29.e21.
Mullender C, da Costa KA, Alrubayyi A, Pett SL, Peppa D. SARS-CoV-2 immunity and vaccine strategies in people with HIV. Oxf Open Immunol 2022; 3(1): iqac005.
Levy I, Rahav G. The effect of HIV on COVID-19 vaccine re-sponses. Curr Opin HIV AIDS 2023; 18(3): 135–41.
Bessen C, Plaza-Sirvent C, Simsek A, Bhat J, Marheinecke C, Urlaub D, et al. Impact of SARS-CoV-2 vaccination on sys-temic immune responses in people living with HIV. Front Immunol 2022; 13: 1049070.
Augello M, Bono V, Rovito R, Tincati C, Marchetti G. Immuno-logic interplay between HIV/AIDS and COVID-19: adding fuel to the flames? Curr HIV/AIDS Rep 2023; 20(2): 51–75.
Ouzounakis P, Frantzana A, Iliadis C, Mihalache A, Alefragkis D, Kourkouta L. HIV infection and vaccinations. World J Adv Res Rev 2023 ; 17(3): 101–6.