COVID-19 hybrid immunity more protective than vaccination alone among people with HIV

March 13, 2024

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Key takeaways:

• Among people with HIV, hybrid COVID-19 immunity is more effective at preventing infection and severe disease vs. vaccination alone.
• Infections lasting more than 50 days suggest potential for a viral reservoir.

DENVER — Among people with HIV, hybrid immunity against COVID-19 is more effective at preventing infection and severe disease than vaccination alone, according to a study.

The finding, from a study conducted in sub-Saharan Africa, aligns with results from previous studies of people without HIV, which have also found that hybrid immunity increases protection against COVID-19.

“Although observational studies have suggested greater vaccine efficacy with hybrid immunity, these have largely excluded people with HIV and have mainly involved high-income countries,” Asa Tapley, MD, MSc, clinical trials physician and protocol team lead at the HIV Vaccine Trials Network, said during a press conference at the Conference on Retroviruses and Opportunistic Infections.

Tapley and colleagues enrolled more than 14,000 people aged 18 years or older in sub-Saharan Africa who had HIV or another comorbidity associated with severe COVID-19 between December 2021 and September 2022.

They assigned participants to receive a vaccine at enrollment only or at enrollment and at 1 month based on whether they were positive for SARS-CoV-2 — indicating hybrid immunity — or negative and followed them for up to 6 months. Among people with HIV, 18.5% had a detectable viral load and 14.5% were not on ART.

At 6 months, the cumulative COVID-19 incidence rate was 7.77% (95% CI, 6.21%-9.23%) among people who were only vaccinated and 3.9% (95% CI, 3.30 to 4.49) among participants with hybrid immunity.

Overall, the risk for SARS-CoV-2 infection in the hybrid immunity group was 42% lower than in the vaccine immunity group and the risk for severe disease and hospitalization was 73% lower.

“We also identified a subpopulation of participants with prolonged SARS-CoV-2 positivity for over 50 — or even 100 — days, particularly in people living with HIV with lower CD4 counts or unsuppressed HIV viral loads,” Tapley said.

This subpopulation is significant “given the large population of individuals with poorly controlled HIV globally who may act as a reservoir for emerging variants, emphasizing the important of further investigating viral persistence, as well as improving access to SARS-CoV-2 antivirals and reinforcing HIV care,” he said.

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Sources/Disclosures

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Source:

Tapley A, et al. Abstract 123. Presented at: Conference on Retroviruses and Opportunistic Infections; March 3-6, 2024; Denver.

Disclosures:
Tapley reports no relevant financial disclosures.

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