Systematic review and meta-analysis of COVID-19 vaccines safety, tolerability, and efficacy among HIV-infected patients

Tamuzi, Jacques L.; Muyaya, Ley Muyaya; Mitra, Amal K.; Nyasulu, Peter

doi:10.1101/2022.01.11.22269049

Cited by 10 publications

(9 citation statements)

References 78 publications

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“…Concerningly, we found an increasing and high proportion of patients with CD4 <200 cells/µL and VL ≥1000 copies/ml, possibly reflecting gaps in HIV care earlier in the pandemic. Second, we need to determine and implement the most effective SARS-CoV-2 vaccination strategies for PWH [10]. Third, comorbidity diagnosis and management in PWH should be optimized, with a particular focus on diagnosis and treatment of tuberculosis which has been severely impacted by COVID-19 [25].…”

Section: Discussionmentioning

confidence: 99%

“…The recent WHO Global Clinical Platform of COVID-19 study showed that being on ART and/or virally suppressed was protective against poor COVID-19 outcomes in hospitalized patients, but there is limited data on all COVID-19 patients including those not admitted, and the effect of immunosuppression before the COVID-19 episode [7, 8]. Furthermore, the effectiveness of vaccination in preventing severe COVID-19 in PWH in this context remains unclear [9, 10].…”

Section: Introductionmentioning

confidence: 99%

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COVID-19 among adults living with HIV: Correlates of mortality in a general population in a resource-limited setting

Kassanjee

Davies

Ngwenya

et al. 2022

Preprint

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Introduction: While a large proportion of people with HIV (PWH) have experienced SARS-CoV-2 infections, there is uncertainty about the role of HIV disease severity on COVID-19 outcomes, especially in lower income settings. We studied the association between mortality and characteristics of HIV severity and management, and vaccination, among adult PWH. Methods: We analysed observational cohort data on all PWH aged ≥15 years experiencing a diagnosed SARS-CoV-2 infection (until March 2022), who accessed public sector healthcare in the Western Cape province of South Africa. Logistic regression was used to study the association of mortality with CD4 cell count, viral load, evidence of ART, time since first HIV evidence, and vaccination, adjusting for demographic characteristics, comorbidities, admission pressure, location and time period. Results: Mortality occurred in 5.7% (95% CI: 5.3,6.0) of 17 831 first diagnosed infections. Higher mortality was associated with lower recent CD4, no evidence of ART collection, high or unknown recent viral load (among those with ART evidence), and recent first HIV evidence, differentially by age. Vaccination was protective. The burden of comorbidities was high, and tuberculosis, chronic kidney disease, diabetes and hypertension were associated with higher mortality, more strongly in younger adults. Conclusions: Mortality was strongly associated with suboptimal HIV control, and prevalence of these risk factors increased in later COVID-19 waves. It remains a public health priority to ensure PWH are on suppressive ART and vaccinated, and manage any disruptions in care that occurred during the pandemic. The diagnosis and management of comorbidities, including for tuberculosis, should be optimised.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

COVID-19 among adults living with HIV: Correlates of mortality in a general population in a resource-limited setting

Kassanjee

Davies

Ngwenya

et al. 2022

Preprint

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“…These comorbidities are caused by ART-related in ammation and ongoing immune dysregulation, which may in uence COVID-19 disease severity, the durability of protective antiviral responses, and vaccine responsiveness [19][20][21][22]. According to a recent non-peer reviewed systematic review, COVID-19 vaccines had lower immunogenicity and antigenicity among PLWH, than among HIV negative people [23]. Furthermore, PLWH require more attention during the COVID-19 pandemic because the emergence of Omicron in Southern Africa has raised the question of whether this heavily mutated variant is the result of the HIV pandemic, a common cause of immunode ciency in the region [3].…”

Section: Introductionmentioning

confidence: 99%

The epidemiological and clinical characteristics of COVID-19 in a high HIV/TB burden district level hospital setting

Mnguni

Schietekat²,

Ebrahim³

et al. 2022

Preprint

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Background: The coronavirus disease 2019 (COVID-19) pandemic continues to evolve. Globally, COVID-19 continues to strain even the most resilient healthcare systems, with Omicron being the latest variant. We made a thorough search for literature describing the effects of the COVID-19 in a high human immunodeficiency virus (HIV)/tuberculosis (TB) burden district-level hospital setting. We found scanty literature. Methods: A retrospective observational study was conducted at Khayelitsha District Hospital in Cape Town, South Africa (SA) over the period March 2020 – December 2021. We included confirmed COVID-19 cases with HIV infection aged from 18 years and above. Analysis was performed to identify predictors of mortality or hospital discharge among people living with HIV (PLWH). Predictors investigated include CD4 count, antiretroviral therapy (ART), TB, non-communicable diseases, haematological, and biochemical parameters. Findings: This cohort of PLWH with SARS-CoV-2 infection had a median (IQR) age of 46 (37–54) years, male sex distribution of 29.1%, and a median (IQR) CD4 count of 267 (141–457) cells/mm3. Of 255 patients, 195 (76%) patients were discharged, 60 (24%) patients died. One hundred and sixty-nine patients (88%) were on ART with 73(28%) patients having acquired immunodeficiency syndrome (AIDS). After multivariate analysis, smoking (risk ratio [RR]: 2.86 (1.75–4.69)), neutrophilia [RR]: 1.024 (1.01–1.03), and glycated haemoglobin A1 (HbA1c) [RR]: 1.01 (1.007–1.01) were associated with mortality. Conclusion: The district hospital had a high COVID-19 mortality rate among PLWH. Easy-to-access biomarkers such as CRP, neutrophilia, and HbA1c may play a significant role in informing clinical management to prevent high mortality due to COVID-19 in PLWH at the district-level hospitals.

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“…Despite the unquestionable usefulness of SARS-CoV-2 vaccination, fragile categories of patients may show a sub-optimal response to vaccines. Older patients and those with primary or secondary immunodeficiencies showed indeed an impaired antibody-mediated response after SARS-CoV-2 vaccination, remaining at high risk for severe COVID-19 (13)(14)(15)(16). The optimal clinical management of SARS-CoV-2 infection in these patients is represented by early diagnosis and treatment with medication able to minimize the risk of progression towards severe disease.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and Tolerability of Early Treatment with Monoclonal Antibodies against SARS-Cov-2: Results from A Real-Life Study before Omicron Surge

Scotto¹,

Buonomo²,

Zumbo³

et al. 2022

Preprint

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Despite the lightning-fast advances in the management of SARS-CoV after 2 years of pandemic, COVID-19 continues to pose a challenge for fragile patients, who could benefit from early administration of monoclonal antibodies (mAbs) to reduce the risk of severe disease progression. We conducted a prospective study to evaluate effectiveness of mAbs against SARS-CoV-2 among patients at risk for severe disease progression, namely elderly and those with comorbidities, before the omicron variant surge. Patients were treated with either casirivimab/imdevimab, sotrovimab, and bamlanivimab/etesevimab. The rates and risk factos for clinical worsening, hospitalization, ICU admission and death (unfavourable outcomes) were evaluated. A stratified analysis according to the presence of SARS-CoV-2 IgG was also performed. Among 185 included patients, we showed low rates of unfavorable outcomes (9.2%), which were more frequent in patients with chronic kidney disease (aOR: 10.44, 95CI: 1.73-63.03; p<0.05) and basal D-dimer serum concentrations >600 ng/ml (aOR 21.74, 95CI: 1.18-397.70; p<0.05). Patients with negative SARS-CoV-2 serology at baseline showed higher C-reactive protein values compared with patients with positive serology (p <0.05) and showed a trend toward a higher admission rate to SICU and ICU compared with patients with positive serology. Our results thus showed, in a real-life setting, the efficacy of mAbs against SARS-CoV-2 before Omicron surge when the available mabs become not effective.

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Systematic review and meta-analysis of COVID-19 vaccines safety, tolerability, and efficacy among HIV-infected patients

Cited by 10 publications

References 78 publications

COVID-19 among adults living with HIV: Correlates of mortality in a general population in a resource-limited setting

COVID-19 among adults living with HIV: Correlates of mortality in a general population in a resource-limited setting

The epidemiological and clinical characteristics of COVID-19 in a high HIV/TB burden district level hospital setting

Effectiveness and Tolerability of Early Treatment with Monoclonal Antibodies against SARS-Cov-2: Results from A Real-Life Study before Omicron Surge

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