Analysis of Postvaccination Breakthrough COVID-19 Infections Among Adults With HIV in the United States

Coburn, Sally B; Humes, Elizabeth; Lang, Raynell; Stewart, Cameron; Hogan, Brenna; Gebo, Kelly A.; Napravnik, Sonia; Edwards, Jessie K.; Browne, Lindsay; Park, Lesley S.; Justice, Amy C.; Gordon, Kirsha S.; Horberg, Michael A.; Certa, Julia M.; Watson, Eric; Jefferson, Celeena R.; Silverberg, Michael J.; Skarbinski, Jacek; Leyden, Wendy A.; Williams, Carolyn; Althoff, Keri N.

doi:10.1001/jamanetworkopen.2022.15934

Cited by 61 publications

(56 citation statements)

References 34 publications

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“…Furthermore, given the safety of the mRNA vaccines, the overall lower vaccine-inducible antibody response observed in PLWH, the observed waning of serum antibody levels over time, and immune escape by VOCs, we think that providing additional vaccinations to all PLWH may optimise protection. Some recent studies confirm that a third dose in PLWH is beneficial and important in light of more frequent breakthrough infections in PLWH after vaccinations [ 36 , 37 ]. Based on these results, an argument can be made for prioritisation and use of a more targeted approach in, for example, older PLWH, in those with lower CD4+ T-cell counts, or based on measured antibody responses and neutralisation capacity after vaccination.…”

Section: Discussionmentioning

confidence: 99%

Immunogenicity and reactogenicity of SARS-CoV-2 vaccines in people living with HIV in the Netherlands: A nationwide prospective cohort study

Hensley¹,

Jongkees²,

GeurtsvanKessel³

et al. 2022

PLoS Med

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Background Vaccines can be less immunogenic in people living with HIV (PLWH), but for SARS-CoV-2 vaccinations this is unknown. In this study we set out to investigate, for the vaccines currently approved in the Netherlands, the immunogenicity and reactogenicity of SARS-CoV-2 vaccinations in PLWH. Methods and findings We conducted a prospective cohort study to examine the immunogenicity of BNT162b2, mRNA-1273, ChAdOx1-S, and Ad26.COV2.S vaccines in adult PLWH without prior COVID-19, and compared to HIV-negative controls. The primary endpoint was the anti-spike SARS-CoV-2 IgG response after mRNA vaccination. Secondary endpoints included the serological response after vector vaccination, anti-SARS-CoV-2 T-cell response, and reactogenicity. Between 14 February and 7 September 2021, 1,154 PLWH (median age 53 [IQR 44–60] years, 85.5% male) and 440 controls (median age 43 [IQR 33–53] years, 28.6% male) were included in the final analysis. Of the PLWH, 884 received BNT162b2, 100 received mRNA-1273, 150 received ChAdOx1-S, and 20 received Ad26.COV2.S. In the group of PLWH, 99% were on antiretroviral therapy, 97.7% were virally suppressed, and the median CD4+ T-cell count was 710 cells/μL (IQR 520–913). Of the controls, 247 received mRNA-1273, 94 received BNT162b2, 26 received ChAdOx1-S, and 73 received Ad26.COV2.S. After mRNA vaccination, geometric mean antibody concentration was 1,418 BAU/mL in PLWH (95% CI 1322–1523), and after adjustment for age, sex, and vaccine type, HIV status remained associated with a decreased response (0.607, 95% CI 0.508–0.725, p < 0.001). All controls receiving an mRNA vaccine had an adequate response, defined as >300 BAU/mL, whilst in PLWH this response rate was 93.6%. In PLWH vaccinated with mRNA-based vaccines, higher antibody responses were predicted by CD4+ T-cell count 250–500 cells/μL (2.845, 95% CI 1.876–4.314, p < 0.001) or >500 cells/μL (2.936, 95% CI 1.961–4.394, p < 0.001), whilst a viral load > 50 copies/mL was associated with a reduced response (0.454, 95% CI 0.286–0.720, p = 0.001). Increased IFN-γ, CD4+ T-cell, and CD8+ T-cell responses were observed after stimulation with SARS-CoV-2 spike peptides in ELISpot and activation-induced marker assays, comparable to controls. Reactogenicity was generally mild, without vaccine-related serious adverse events. Due to the control of vaccine provision by the Dutch National Institute for Public Health and the Environment, there were some differences between vaccine groups in the age, sex, and CD4+ T-cell counts of recipients. Conclusions After vaccination with BNT162b2 or mRNA-1273, anti-spike SARS-CoV-2 antibody levels were reduced in PLWH compared to HIV-negative controls. To reach and maintain the same serological responses as HIV-negative controls, additional vaccinations are probably required. Trial registration The trial was registered in the Netherlands Trial Register (NL9214). https://www.trialregister.nl/trial/9214.

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Section: Discussionmentioning

confidence: 99%

Immunogenicity and reactogenicity of SARS-CoV-2 vaccines in people living with HIV in the Netherlands: A nationwide prospective cohort study

Hensley¹,

Jongkees²,

GeurtsvanKessel³

et al. 2022

PLoS Med

View full text Add to dashboard Cite

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“…[30][31][32][33] In the event of a breakthrough infection, vaccination will reduce the severity of the illness and lower the likelihood of acquiring COVID-19. 16,[34][35][36] The safety of delivering the currently available SARS-CoV-2 vaccines before, during, and after pregnancy is supported by all available research. 37,38 However, vaccine hesitancy becomes one of the greatest challenges globally.…”

Section: Discussionmentioning

confidence: 99%

A Mixed-Methods Study of COVID-19 Vaccine Acceptance and Its Determinants Among Pregnant Women in Northeast Ethiopia

Tefera

Assefaw

2022

PPA

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Background:The World Health Organization recommends that pregnant women should receive a vaccine against COVID-19. However, COVID-19 vaccine hesitance was one of the barriers to delivering the vaccine, and this issue was not well addressed in Ethiopia. Therefore, we aimed to determine the prevalence of COVID-19 vaccination acceptability and the factors that influence it among pregnant women in Northeast Ethiopia. Methods: A mixed-methods approach comprising both qualitative interviews and a quantitative survey was conducted from January 1-30, 2022. For the quantitative part, a multi-stage sampling technique was used to recruit the study participants (n=702). Data was collected through face-to-face interviews using pretested and structured questionnaires. Bivariate and multivariable logistic regression analyses were employed. The statistical difference was considered at P-0.05, and the strength of association was assessed by the odds ratio and respective 95% confidence intervals. For the qualitative part, 18 participants were selected purposively for in-depth interviews, an interviewer guide was used for data collection and thematic content analysis was performed. Results: In this study, a total of 702 pregnant women were included with the response rate of 100%.

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“…It has been reported that people living with immunocompromised conditions, such as HIV infection, have worse outcomes after SARS-CoV-2 infection than immunocompetent individuals [41,42]. This observation has also been con rmed in an immunosuppressed preclinical model of SARS-CoV-2 infection [43].…”

Section: Discussionmentioning

confidence: 80%

Dynamics of Temporal Immune Responses in Nonhuman Primates and Humans Immunized with COVID-19 Vaccines

Khan

Ravindran

Kang

et al. 2022

Preprint

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We assessed the humoral immune responses to a COVID-19 vaccine in a well-controlled rhesus macaque model in comparison to humans immunized with two mRNA vaccines over several months post-second dose. The plasma IgG levels against seven coronaviruses (including SARS-CoV-2) and antibody subtypes (IgG1-4 and IgM) against SARS-CoV-2 were evaluated using multiplex assays. The neutralization capacity of plasma antibodies against original SAR-CoV-2 isolate and nine variants was evaluated in vaccinated humans and non-human primates. Immunization of macaques and humans with SARS-CoV-2 vaccines induced a robust neutralizing antibody response. In non-SIV infected adult macaques immunized with an adenoviral vector expressing S-RBD (n = 7) or N protein (n = 3), elevated levels of IgG and neutralizing antibodies were detected 2 weeks post-second dose. Immune responses to the S-RBD vaccine in SIV-infected adult macaques (n = 2) were similar to the non-SIV-infected animals. Adult humans immunized with Pfizer (n = 35) or Moderna (n = 18) vaccines developed IgG and neutralizing antibodies at 4 weeks post-second dose. In both vaccine groups, IgG 1 was the predominant subtype, followed by IgG 3. The IgG levels, including total and IgG1,2,3 elicited by Moderna vaccine, were significantly higher than the corresponding levels elicited by the Pfizer vaccine at 4 weeks post-second dose. A significant correlation was observed between the plasma total IgG antibody levels and neutralization titers in both macaques and humans. Furthermore, broad-spectrum neutralization antibodies against several variants of SARS-CoV-2 were detected in the plasma of both macaques and humans after two vaccinations.

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Analysis of Postvaccination Breakthrough COVID-19 Infections Among Adults With HIV in the United States

Cited by 61 publications

References 34 publications

Immunogenicity and reactogenicity of SARS-CoV-2 vaccines in people living with HIV in the Netherlands: A nationwide prospective cohort study

Immunogenicity and reactogenicity of SARS-CoV-2 vaccines in people living with HIV in the Netherlands: A nationwide prospective cohort study

A Mixed-Methods Study of COVID-19 Vaccine Acceptance and Its Determinants Among Pregnant Women in Northeast Ethiopia

Dynamics of Temporal Immune Responses in Nonhuman Primates and Humans Immunized with COVID-19 Vaccines

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