Safety and immunogenicity of inactivated SARS-CoV-2 vaccines in people living with HIV

Abstract

It is important to know the safety and efficacy of vaccination in immunocompromised people living with HIV (PLWH), but currently, there is limited data on the inactivated SARS-CoV-2 vaccines' safety and immune responses in PLWH. In this prospective observational study, 139 PLWH and 120 healthy controls were enrolled and monitored for 21-105 days after a two-dose vaccination. The safety, anti-receptor binding domain IgG (anti-RBD-IgG) and anti-spike-IgG responses, and RBD-specific memory B cell (MBC) responses were evaluated. The overall adverse events within seven days were reported in 12.9% (18/139) of PLWH and 13.3% (16/120) of healthy controls. No serious adverse events occurred in both groups. Overall, the seroprevalence of anti-RBD-IgG in PLWH was significantly decreased (87.1% vs. 99.2%; p<0.001). The geometric mean end-point titer (GMT) of anti-RBD-IgG in PLWH was also reduced, especially in patients with CD4 counts <200 cells/µL, regardless of age, gender, or HIV viral load. GMTs of anti-RBD-IgG in both PLWH and healthy controls declined gradually over time. Similar results were also observed in the anti-spike-IgG response. The frequency of RBD-specific MBCs in PLWH decreased (p<0.05), and then remained stable over time. Lastly, through multivariate analysis, we found the factors that predicted a less robust response to inactivated vaccines in PLWH were a low CD4 count and long time interval after vaccination. In conclusion, inactivated vaccines are well-tolerated in PLWH but with low immunogenicity. Therefore, SARS-CoV-2 vaccines and booster doses should be given priority in PLWH, especially in patients with low CD4 counts.Trial registration: ClinicalTrials.gov identifier: NCT05043129..

Keywords: COVID-19; PLWH; SARS-CoV-2 vaccine; humoral immune response; safety.

Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.

Antibody responses to inactivated vaccines in people living with HIV (PLWH). The seropositivity rate and titers of (A) anti-receptor binding domain (RBD)-IgG and (B) anti-spike-IgG in PLWH and healthy controls. The seropositivity rate and titers of (C) anti-RBD-IgG and (D) anti-spike-IgG in PLWH with different CD4 count levels. The horizontal dotted lines represent the limit of detection.

Figure 2.

Specific memory B cell (MBC) responses to inactivated vaccines in people living with HIV (PLWH). The frequencies of (A) receptor binding domain (RBD)-specific MBCs, (B) resting MBCs, (C) activated MBCs, (D) intermediate MBCs, and (E) atypical MBCs in PLWH and healthy controls. The frequencies of (F) RBD-specific MBCs, (G) rMBCs, (H) actMBCs, (I) intMBCs, and (J) atyMBCs in PLWH with different CD4 count levels.

Figure 3.

Antibody responses and specific memory B cell (MBC) responses to inactivated vaccines over time. The seropositivity rate and titers of anti-receptor binding domain (RBD)-IgG (A) and anti-spike-IgG (B) after 1, 2, and 3 months in people living with HIV (PLWH) and healthy controls. (C)The frequencies of RBD-specific MBCs, rMBCs, actMBCs, intMBCs, and atyMBCs after 1, 2, and 3 months in PLWH and healthy controls. The horizontal dotted lines represent the limit of detection.

Figure 4.

The longitudinal dynamic changes of humoral responses to inactivated SARS-CoV-2 vaccines in people living with HIV (PLWH). The dynamic changes of anti-receptor binding domain (RBD)-IgG (A) and anti-spike-IgG (B) titers in PLWH from month 1 to month 6 post-vaccination. The dynamic changes of frequencies of (C) RBD-specific MBCs, (D) rMBCs, (E) actMBCs, (F) intMBCs, and (G) atyMBCs in PLWH from month 1 to month 6 after vaccination. The horizontal dotted lines represent the limit of detection.