Impaired antibody response to COVID-19 vaccination in advanced HIV infection

Objectives: Coronavirus disease 2019 (COVID-19) vaccination is reportedly efficient in people with HIV (PWH) but vaccine trials included participants with normal CD4(+) T-cell counts. We analyzed seroconversion rates and antibody titers following two-dose vaccination in PWH with impaired CD4(+) T-cell counts. Methods: We collected retrospective postvaccination SARS-COV-2 serology results available in a university hospital for PWH vaccinated between March and September, 2021 who were tested for antispike antibodies from 8 to 150 days following dose 2. Antibody titers were compared in PWH with CD4(+) T-cell count less than 200 cells/mu l, 200 Results: One hundred and five PWH were included: n = 54 in the CD4(+) T-cell count less than 500 cells/mu l group (n = 18 with CD4(+) <200 cells/mu l, n = 36 with 200 < CD4(+) < 500 cells/mu l) and 51 in the CD4(+) T-cell count greater than 500 cells/mu l group. They received two doses of BNT162b2 (75%), mRNA-1273 (8.5%), or ChAdOx1 nCoV-19 (16.5%). The median time from vaccine dose 2 to serology was consistent across all groups (73 days, interquartile range [29-97], P = 0.14). Seroconversion rates were 100% in the CD4(+) T-cell count greater than 500 cells/mu l group but 89% in participants with CD4(+) T-cell counts less than 500 cells/mu l (22 and 5.5% seronegative in the CD4(+) T-cell counts <200 cells/mu l and 200 < CD4(+) < 500 cells/mu l groups, respectively). Median antibody titers were 623.8 BAU/ml [262.2-2288] in the CD4(+) greater than 500 cells/mu l group versus 334.3 BAU/ml [69.9-933.9] in the CD4(+) less than 500 cells/mu l group (P = 0.003). They were lowest in the CD4(+) less than 200 cells/mu l group: 247.9 BAU/ml [5.88-434.9] (P = 0.0017) with only 44% achieving antibody titers above the putative protection threshold of 260 BAU/ml. Conclusion: PWH with CD4(+) T-cell counts less than 500 cells/mu l and notably less than 200 cells/mu l had significantly lower seroconversion rates and antispike antibody titers compared with PWH with CD4(+) T-cell counts greater than 500 cells/mu l, warranting the consideration of targeted vaccine strategies in this fragile population.