Enhanced humoral and cellular immunogenicity of COVID-19 vaccines in people living with HIV: A real-world analysis.

BACKGROUND

Immunogenicity between mRNA and protein subunit coronavirus disease 2019 (COVID-19) vaccines in people living with HIV (PLWH) remained limited. We aimed to investigate the immunogenicity after different types of COVID-19 vaccines in PLWH and non-HIV individuals.

MATERIALS AND

METHODS

The prospective observational study encompassed PLWH and non-HIV adults after primary-booster vaccinations. Humoral immunogenicity was evaluated by serum anti-spike-protein antibody (S-Ab) titer and neutralizing antibody (Nu-Ab) activity by surrogate virus neutralization assay, while cellular immunogenicity of interferon-gamma (IFN-γ) reactivity by Covi-FERON ELISA assay. The linear mixed-effects model was used for controlling confounding variables.

RESULTS

Overall 188 PLWH and 192 non-HIV participants were enrolled. The S-Ab titers were significantly lower in PLWH than non-HIV participants after controlling for confounders (P = 0.01). In PLWH, booster with an mRNA vaccine elicited higher S-Ab titers (8,709 U/mL vs. 3,690 U/mL, P = 0.049) and a greater likelihood of Nu-Ab activity (57 % vs. 32 %, P = 0.03) than a protein subunit vaccine. Homologous mRNA/mRNA/mRNA strategy produced higher S-Ab titers (15,490 U/mL vs. 7,415 U/mL, P < 0.01) and positive Nu-Ab activity (71 % vs. 49 %, P = 0.02) than heterologous ChAdO × 1-ChAdO × 1-mRNA regimens. Cellular immunity was comparable between PLWH and non-HIV individuals, though PLWH with CD4 counts ≥200 cells/μL were more likely to exhibit reactive IFN-γ responses (99 % vs. 83 %, P = 0.04).

CONCLUSION

Primary-booster mRNA vaccination elicited stronger humoral responses than heterologous regimens in PLWH. However, additional booster vaccines may be necessary for PLWH with low CD4 counts and diminished cellular immunity despite vaccination. These findings highlight the importance of tailored vaccination strategies for the immunocompromised population.