Infectious Disease

People with HIV do not respond as well to COVID-19 vaccines, according to the study

October 03, 2021

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SpinelliM, et al. Summary LB8. Presented at: IDWeek; September 29th-Oct. 02/03/2021 (virtual meeting).

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The authors do not report any relevant financial information.

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People with HIV react less robustly to the COVID-19 vaccination than people without HIV, as the data presented at IDWeek suggest.

Matthew Spinelli, MD, MAS, Assistant Professor of Medicine at the University of California, San Francisco, and colleagues compared 100 people with HIV to 100 adult patients without HIV who were treated for chronic illness in a San Francisco clinic for at least 10 days after receiving the second dose of COVID -19 Messenger RNA Vaccine.

SpinelliM, et al.  Summary LB8.  Presented at: IDWeek;  September 29th-Oct.  02/03/2021 (virtual meeting).

SpinelliM, et al. Summary LB8. Presented at: IDWeek; September 29th-Oct. 02/03/2021 (virtual meeting).

In both groups, 25 participants received the Moderna vaccine and the other 75 participants received the Pfizer vaccine. Each group consisted of 13 women. The average age of all participants was 59 years. The median time between vaccination doses was 35 days (interquartile range [IQR], 20-63).

Those with HIV had a median CD4 + T cell count of 511 (IQR, 351-796) and five people had HIV RNA greater than 200.

According to the researchers, people with HIV were 2.4 times more likely to fail to respond to pseudovirus-neutralizing antibodies than people without HIV (95% CI, 1.1-5.4). In addition, the continuous anti-RBD IgG concentrations were 43% lower (95% CI 0.36-0.88) in those infected with HIV.

“The factors that predicted a less robust response were lower CD4 counts, unsuppressed viral loads, and receiving the Pfizer rather than the Moderna vaccine.” Monica Gandhi, MD, MPH, Professor of medicine and assistant director of HIV, Infectious Diseases and Global Medicine at the University of California at San Francisco and co-author of the study, Healio said.

After adjusting for age, gender, and days after vaccination, every 100-cell increase in CD4 + T cell counts was associated with a 22% increase in neutralizing antibody titers in HIV-infected individuals, and 89% lower neutralizing antibody titers.

The authors reported that taking the Pfizer vaccine was associated with 77% lower neutralization titers compared to the Moderna vaccine.

“With the data currently available, plans to give people with HIV a booster vaccination seem to make sense, especially for those with lower CD4 + counts or unsuppressed viral loads, although effective antiretroviral therapy is very important for these patients too,” Spinelli told Healio. “The next steps include the investigation of the T-cell responses as well as the immune responses to a booster vaccination that has already started on site in people with HIV.”

The FDA has approved booster doses of Pfizer’s COVID-19 vaccine for immunocompromised people 65 years of age or older, or at risk for serious infection. The FDA plans to meet on October 14-15 to discuss booster doses of Moderna and Johnson & Johnson’s COVID-19 vaccine.

The NIH in March recommended prioritizing people with HIV as a high-risk group for COVID-19 vaccination based on some research that showed they were at increased risk of death or worse outcomes.

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