New Study on COVID-19 mRNA Vaccine Response of People Living with HIV

07.12.2023 ORCHESTRA researchers compared in a logistic regression the probability of not achieving robust/above-average responses to the COVID-19 mRNA vaccine in people living with HIV (PLWH) who received ≥2 doses. Specifically, the study aimed to describe the average humoral response to COVID-19 mRNA vaccination in 1,176  PLWH from the HIV cohort of Orchestra WP4 study from 1st dose to 6 months after the 3rd dose. The paper evaluated the rates of not achieving a robust/above-average humoral response, using 2 different cut-offs approximating correlates of protection and investigated the role of 2 well-studied HIV markers (CD4 cell count and CD4/CD8 ratio measured before starting the vaccination) in predicting the response.

 

The results have shown that proportions of PLWH failing to achieve a robust/above-average response were significantly higher in participants with lower CD4 count (particularly for the group with CD4<200 cells/mm3) and lower CD4/CD8 ratio, but, a stronger gradient was observed for the CD4 count. The CD4 count was a better predictor than CD4/CD8 ratio of the 30-day humoral response after the primary cycle.   Again, PLWH with CD4 < 200 cells/mm3 showed a higher risk of not achieving a robust/above-average response compared to participants with a higher count. CD4 count level before vaccination was less predictive of the humoral response to the vaccine 3rd dose. The 3rd dose was pivotal in achieving a robust/above-average humoral response, at least for PLWH with CD4 > 200 cells/mm3.

 

The researchers conclude that “CD4 cell counts remain the most solid marker to guide vaccination campaigns in PLWH”.  Considering the higher risk of worse outcomes after infection, PLWH with more severe immunosuppression, such as subjects with CD4 <200 cells/mm3, “should be always prioritized for vaccination – and booster – campaigns. The 3rd booster dose proved to be essential to overcome waning of humoral response and to push this response back to a level associated with protection from infection”.

 

Read the full article here: https://www.mdpi.com/2076-393X/11/11/1664