Durability of ChAdOx1 nCov-19 (AZD1222) vaccination in people living with HIV - responses to SARS-CoV-2, variants of concern and circulating coronaviruses

Abstract

Duration of protection from SARS-CoV-2 infection in people with HIV (PWH) following vaccination is unclear. In a sub-study of the phase 2/3 the COV002 trial (NCT04400838), 54 HIV positive male participants on antiretroviral therapy (undetectable viral loads, CD4+ T cells >350 cells/ul) received two doses of ChAdOx1 nCoV-19 (AZD1222) 4-6 weeks apart and were followed for 6 months. Responses to vaccination were determined by serology (IgG ELISA and MesoScale Discovery (MSD)), neutralisation, ACE-2 inhibition, gamma interferon ELISpot, activation-induced marker (AIM) assay and T cell proliferation. We show that 6 months after vaccination the majority of measurable immune responses were greater than pre-vaccination baseline, but with evidence of a decline in both humoral and cell mediated immunity. There was, however, no significant difference compared to a cohort of HIV-uninfected individuals vaccinated with the same regimen. Responses to the variants of concern were detectable, although were lower than wild type. Pre-existing cross-reactive T cell responses to SARS-CoV-2 spike were associated with greater post-vaccine immunity and correlated with prior exposure to beta coronaviruses. These data support the on-going policy to vaccinate PWH against SARS-CoV-2, and underpin the need for long-term monitoring of responses after vaccination.

Systematic review and meta-analysis of COVID-19 vaccines safety, tolerability, and efficacy among HIV-infected patients

“…Sixteen out of twenty-three studies reported the HIV viral load. Among them, six studies included PLWH with viral load < 50 copies/ml [16,45,49,51,53,54] and ten others included PLWH with viral load 58.1% to 95% suppressed [44,46,52,55,56,58,60,61,63,65].…”

“…However, three studies involving mRNA vaccines and heterogeneous (mRNA and viral vector vaccines) showed statistically higher MD than viral vector and inactivated vaccines [53,58,60]. Meta-regression revealed no relationship between the level of IgG antibodies and the median CD4 count greater than 280 cells/L or age greater than 18 years.…”

“…2) [16,53], Canada (n=2) [ 47,51], Italia (n=1) [58], Brazil (n =1) [56], Germany (n =1) [60], Israel (n = 1) [44], Sweden (n=1) [64], Taiwan (n=1) [65] and Russia (n = 1) [62] (Figure 2). Ten studies used randomized control designs [16,45,46,49,50,53,54,64,64,65], eight studies used prospective cohort designs [44,47,48,51,52,[56][57][58], two retrospective cohort studies [62,63], two cross sectional studies [59,61] and one case control study [55] (Supplementary material: Table 1 1)…”

“…Regarding the risk of bias of non-randomized studies, sixteen studies were assessed with the ROBIN-I bias tool assessment [26]. Among them, seven were rated as low-moderate for the overall ROBIN-I [44,51,52,55,57,58,60], four studies were low-serious [53,54,56,62], one study was moderate-serious [61], another study was Serious-Critical [48] and two studies were critical [47,59] (Supplementary material: Table 3).…”

“…47,48,50,51,53,55,58,60,63,64], six studies included inactivated vaccines including CoronaVac (3 μg/0.5 mL), BBIBP-CorV (4 μg/0.5 mL) or Sinovac (0.5 ml)given intramuscularly […”