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

October 03, 2021

2 min read


Spinelli M, et al. Abstract LB8. Presented at: IDWeek; Sept. 29-Oct. 3, 2021 (virtual meeting).

The authors report no relevant financial disclosures.

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People with HIV have a less robust response to COVID-19 vaccination than those without HIV, data presented at IDWeek suggest.

Matthew Spinelli, MD, MAS, assistant professor of medicine at the University of California, San Francisco, and colleagues matched 100 people with HIV with 100 adult patients without HIV who were receiving care at a San Francisco clinic for chronic medical conditions at least 10 days after receiving the second dose of a COVID-19 messenger RNA vaccine.

Spinelli M, et al. Abstract LB8. Presented at: IDWeek; Sept. 29-Oct. 3, 2021 (virtual meeting).

Spinelli M, et al. Abstract LB8. Presented at: IDWeek; Sept. 29-Oct. 3, 2021 (virtual meeting).

In both groups, 25 participants received Moderna’s vaccine and the other 75 participants received Pfizer’s vaccine. Each group had 13 women. The median age of all participants was 59 years. The median time between vaccine 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 an HIV RNA greater than 200.

According to the researchers, the odds of pseudovirus neutralizing antibody nonresponse was a 2.4-fold greater among people with HIV compared with those without HIV (95% CI, 1.1-5.4). Additionally, continuous anti-RBD IgG concentrations were 43% lower in those with HIV (95% CI, 0.36-0.88).

“The factors that predicted a less robust response were a lower CD4 count, non-suppressed viral load and getting the Pfizer, rather than the Moderna, vaccine,” Monica Gandhi, MD, MPH, professor of medicine and associate chief of the division of HIV, infectious diseases and global medicine at the University of California, San Francisco, and coauthor of the study, told Healio.

Following an adjustment for age, sex and days after vaccination, each 100-cell increase in CD4+T-cell count was associated with a 22% increase in neutralizing antibody titers, among those living with HIV Additionally, unsuppressed HIV RNA greater than 200 was associated with 89% lower neutralizing antibody titers.

The authors reported that receipt of the Pfizer vaccine was associated with 77% lower neutralizing titers compared with the Moderna vaccine.

“Plans to provide boosters to people living with HIV, with the data currently available, seem reasonable, particularly to those with lower CD4+ counts or unsuppressed viral loads, although effective antiretroviral therapy is also very important for these patients,” Spinelli told Healio. “Next steps include examining T cell responses, as well as immune responses to booster vaccination, which has already started locally among people living with HIV.”

The FDA has authorized booster doses of Pfizer’s COVID-19 vaccine for people who are immunocompromised, aged 65 years or older, or who are at risk for severe infection. The FDA plans to meet on Oct. 14 and 15 to discuss booster doses of the Moderna and Johnson & Johnson COVID-19 vaccine.

The NIH in March recommended that people with HIV be prioritized for COVID-19 vaccination as a high-risk group based on some research that has shown they are at an increase risk for death or poorer outcomes.

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